The purpose of this request form is to assemble information about your case to make a reasonable estimate of what is the best next step toward solving your problem; what you can do yourself in the way of self-help; and what, if any, professional service(s) we might suggest. May we contact you for additional information? Please provide an appropriate private e-mail address and/or phone number, or in the alternative, indicate the best method of contacting you in the comments section. * Indicates required items. The remainder is optional.

Please identify yourself:

Your Name
Your Company
City
State/Prov.
Country

How can we contact you? Choose at least one of:

Your Phone Number?
Your E-Mail Address?

Have you sought other advice or assistance?

ie: We have consulted legal counsel and our local police authorities. or "Not yet")

Please describe your situation.

Our Privacy Policy

Copyright © 1993-2004 MPRM Group Limited. All rights reserved. Revised: May 05, 2000