Toxic Mold Attorney

Small Claims

1. Please Fax the Following Documents to 866-435-8529

2. Please Complete This Form

Small Claims Information
Name :
Address
City, State, Zip
E-Mail :
Telephone	- -
FAX :	- -
Type Case
Start Date of Incident	/ /
Ending Date	/ /
No. of Defendants
Best time to Contact	Morning Afternoon Evening
Are There Other Witnesses	Yes No
Do you have written documents?	Yes No
Witness Address
Witness City, State, Zip
Witness Telephone	- -
Defendant Address
Defendant City, State, Zip
Defendant Telephone	- -
Describe Case

3. Please Send Payment

Phone: 1-866-935-8529
Fax: 1-866-435-8529

Email: val@flvlaw.com

Address:

Law Offices of Fred L. Valentine, Jr.

3535 Inland Empire Blvd,

Ontario, CA 91764

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