Disclaimer and Notice
This Legal Intake form does not give legal advice, and you should not rely on it as legal advice. This Legal Intake form is not a solicitation or an offer by Belgum, Fry & Van Allen to represent you. We cannot promise you that the information you provide will lead to any specific action on the part of Belgum, Fry & Van Allen. If you fill out this Legal Intake form, you agree that Belgum, Fry & Van Allen may use the information you give us, as long as we don’t include your name, email address, or phone number, for one or more of the following purposes: (1) legislative testimony; (2) litigation; (3) contacting a city, state, or federal agency; or (4) telling your story to the public, including the media. If Belgum, Fry & Van Allen wants to identify you, we will contact you prior to doing so. We will keep your name, address, email address, and telephone number confidential unless you give us permission to use it or unless we are ordered to turn it over by a court (although we will attempt to prevent any disclosure).
All fields are required to submit your form.