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

	Name:
	Address:
	Phone:
	E-Mail:
	Date of Employment Violation:
	Description Of Employment Violation (Fired, Demoted, Denied Promotion or Benefits, Sexual Harassment, Age, Race, Gender or Other Discrimination)
	Describe How The Violation Occurred-Listing Specific Acts:
	Describe Any Deadlines You Are Aware Of:
	Describe Your Losses That Resulted:
	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