ContactName* First Last Email* Phone*Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please Detail Your Current Legal SituationIncident Date (If Applicable) MM slash DD slash YYYY Additional CommentsPlease do not send any sensitive or confidential information with this form.EmailThis field is for validation purposes and should be left unchanged. Contact usADDRESS 42850 Garfield Rd., Suite 104 Clinton Township, MI 48038OFFICE PHONE (586) 286-4454FAX (586) 286-4458EMAIL jciaramitaro3@gmail.com