Benzene Case Inquiry Form

Have you or a loved one been exposed to benzene and have been diagnosed with cancer or leukemia? Has a loved one died from cancer or leukemia caused by benzene exposure?

If yes, you may be eligible for an individual benzene lawsuit or a class action benzene lawsuit. Please supply Williams Cuker Berezofsky with a few facts and we can help you determine where you stand and what to do next.

Free Case Evaluation

* denotes required fields
Personal Information
* Name
* Address
City
State
Zip Code
Daytime Phone Number
Evening Phone
Mobile Phone
* E-mail Address
   
Case Information
Were you exposed to benzene at work?
 
Yes
No
Were you exposed to benzene in drinking water?
 
Yes
No
Were you exposed to benzene in groundwater?
 
Yes
No
Describe your benzene injury:
 
Have you been diagnosed with any of the following:
 
Acute Myelogenous Leukemia (AML)
Non-Hodgkin’s Lymphoma
Chronic Cymphocytic Leukemia
Myelodysplastic Syndrome (MDS)
Myelofibrosis and Myeloid Metaplasia
Aplastic Anemia
Acute Lymphocytic Leukemia (ALL)
Hairy Cell Leukemia
Multiple Myeloma
Thrombocytopenic Purpura
Chronic Myelogenous Leukemia (CML)
Hematologic Cancers
Other (Specify)
Has anyone in your community had similar experiences with benzene?
 
Additional Comments & Questions:
 
 
* By typing "agree" into the below box you are confirming that you wish to send your information to Williams Cuker Berezofsky.