IF YOU THINK YOU HAVE BEEN A VICTIM OF HOUSING DISCRIMINATION TAKE THIS BRIEF SURVEY AND ONE OF OUR LAWYERS WITH CONTACT YOU TO DISCUSS YOUR RIGHTS.

Rental Housing Discrimination Survey

First Name *

Last Name *

Address

Address 2

City *

State/Province *

Zip/Postal Code

Phone *

Email Address *

Preferred way to contact *

Phone

Email

Any

Discrimination Type (select all that apply) *

Please describe in detail your experience. If possible include the date, property address, landlord, agent or managers name. *

Terms and Conditions *

You consent to receive communications from us electronically. We will communicate with you by e-mail or phone. You agree that all agreements, notices, disclosures and other communications that we provide to you electronically satisfy any legal requirement that such communications be in writing.

race or color	creed	lawful source of income	familial status
age	Service or support animal	national origin	immigration or citizenship status,
gender,	sexual orientation	disability,	marital status
partnership status	caregiver status,	familial status	other other