VIOLENCE AGAINST WOMEN ACT

Questionnaire:
Please print out the entire questionnaire, fill out completely, and then mail or fax the completed questionnaire, along with a money order or pay online for $300.00 (Personal check not accepted)

PLEASE DO NOT:
ANSWER THE QUESTIONNAIRE ON LINE OR E-MAIL QUESTIONS TO US.

Fax:
(818) 543-5801
-or-
Mail:
Law Offices of Michael J. Gurfinkel, Inc. 219 North Brand Boulevard Glendale, CA 91203-2609 Attention: In-Take Department

If you wish to print out the questionnaire from our website in pdf format, Click here