Please use the following form to contact us with questions relating to your injury case:

Name:
Address:
Phone:
E-Mail:
Date of Injury:
Describe Any Deadlines You Are Aware Of:
Describe How The Accident or Injuries happened:
Describe The Injuries That Resulted:
Estimate of Automobile Damage:
Estimate of Medical Bills To Date:
Estimate of Future Medical Bills or Care Needs:
Estimate of Wage Loss To Date:
Estimate of Future Wage Loss:

Your Comments and Questions:

Telephone:
(206) 447-1615 or (360) 331-4961
Facsimile:
(360) 331-7755

P. O. Box 625
Freeland, WA 98249

E-mail: moote@petermoote.com

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