Marshall Thomas Burnett Telephone Number

What is My Sinkhole Claim Worth?

Sinkhole Evaluation Form

I understand and agree that by submitting this questionnaire, I will not be charged for an initial response. I also understand that I am forming only a semi-confidential relationship. I agree that by providing information via this form does not constitute a request for legal advice and that I am not forming an attorney-client relationship by submitting this form.

I understand that I may only retain an attorney by entering into a fee agreement and that I am NOT hereby entering into a fee agreement. I agree that the information that I may receive in response to my submitting this questionnaire is general information and I will not be charged for the response. I further understand that the law for each state may vary and therefore I will not rely upon this information as legal advice. Since this matter may require advice regarding my home state, I agree that local counsel may be contacted for referral of this matter.

Your Full Name*
Mailing Address
City
State
Zip
Home Telephone*
Work Telephone
Mobile Telephone
Fax
Additional Contact Information
Employer
Employer Address
City
State
Zip
Street address where you suspect sinkhole activity
City
State
Zip
What is the best way to reach you?
What is the name of your insurance company?
When did you first notice or suspect sinkhole activity?
Is this property your primary residence?

Yes No
Do you own or rent the property where you suspect sinkhole activity?

Rent  Own
Have you contacted your insurance company regarding this matter?

Yes No
Have you contacted any other attorneys regarding this matter?

Yes No
Has your insurance company sent an adjuster to meet with you and examine your claim?

Yes No
Has your insurance company sent an engineering firm out to your property for testing?

Yes No
Has your insurance company confirmed a sinkhole on your property?

Yes No
Please provide any other additional information
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