The Law Offices of Robert Ozeran Intake Form Start by typing the lead name below. First Name Last Name Phone Email Now please complete details below.Describe the lead potential case.What category does the lead potential case fall under?DiscriminationWrongful TerminationSexual HarassmentEqual PayPregnancy DiscriminationWage and HourRetaliationCivil RightsSexual AbuseSeveranceMedical DiscriminationI do not knowDefendant NameDefendant Location- Select the state where the defendant is located -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Estimated Number of Employees at the Location- Select number of employees -1 - 56 - 1011 - 1516 - 2021 - 2526 - 3031 - 3536 - 4041 - 4546 - 5051 - 5556 - 6061 - 6566 - 7071 - 7576 - 8081 - 8586 - 9091 - 9596 - 100100+ Lead Employment Status- Select the lead employment status -TerminatedEmployedSuspendedProbationQuitOther Lead Preferred Language- Select language -EnglishSpanishFarsiOther Lead Preferred Communication- Select communication type -TextCallEmail Marketing Source- Select marketing source -The Law Offices of Robert Ozeran Available fromTime Available toTime SubmitAvailable fromAvailable toCase Category