Information Center Toxic Mold

Toxic Mold Contact Form

Personal Information

Full name

Maiden name

Other names used

Contact Information

E-mail address

Home phone number

Work phone number

Cell phone number

Address

City

State

Zip

Please answer the following to the best of your ability:

I suspect a mold problem at:
My place of business
My home 
My rental property
Other

If the suspected mold problem is at your home, when was the home built?

If you did not build your home, when did you purchase it?

Please check any of the following warning signs if you have noticed them in the relevant building:
Visible mold growth
Discoloration or water stains on internally facing walls or ceilings
Discoloration or water stains on externally facing walls
Areas of standing water or condensation on floors, walls, or window sills
Musty odor

Please check any of the following health effects if you have experienced them:
Worsening of allergies
Respiratory problems
Fever
Nasal and sinus congestion
Burning or watering eyes
Worsening of asthma
Coughing
Sore throat
Flulike symptoms
Skin irritation
Headaches

Please list the name of the general contractor who built your home (if applicable):

Please list any other relevant information or concerns:

Copyright ©2009 FindLaw, a Thomson Business

DISCLAIMER: This site and any information contained herein are intended for informational purposes only and should not be construed as legal advice. Seek competent legal counsel for advice on any legal matter.