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Car Seat Failure Inquiry Do you need a car seat injury lawyer to fight for you? Do you have a car seat injury lawsuit? Isn’t it about time to consider the options and get results? Please fill out the car seat injury pre-case form. Your information is kept in the strictest confidence. PERSONAL INFORMATION
First Name:
Last Name:
E-mail Address:
Address:

City:
State:
Zipcode:
Phone:	() - ext.
Best Method and times to contact you:
ACCIDENT INFORMATION
Date of Accident:
Accident description:

Injury description:

CAR SEAT INFORMATION
Make/Manufacturer of car seat:
Model of car seat:
Approximate date of purchase:
OTHER INFORMATION
Additional Comments:

Car Seat Failure Inquiry