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The forms listed below, including our Standard Fee Agreement, have been prepared in easy, downloadable form. We found these forms to be particularly useful in obtaining medical records, Social Security earnings history and tax records. Click on the form you want to download and you can print it, fill it out by hand and mail it to the appropriate address.

(1) Our Standard Fee Agreement

This is our Standard Fee Agreement, which, if we agree to represent you, may be downloaded, signed, and returned to us. The agreement does not apply, and we do not represent you, until we have received in our office a copy with your actual signature, by mail or by fax.

(2) Social Security Records

You will find this form at the following link:
Request For Social Security Earnings Information

This form has instruction pages - the part you fill out and mail is page #2.
Mail this form, SSA 7050, along with a check for $35.00, to:

Social Security Administration
300 N Greene St.
P.O. Box 33003
Baltimore, MD 21290-3003

Be sure to check box 2(a) for a complete earnings history.

(3) Income Tax Records

This is IRS Form 4506 for obtaining copies of your tax records, which are especially useful in establishing your earnings. The cost is $23.00 per year, or $92.00 for four years. Each form requests up to four years of records. The address is:

Internal Revenue Service
P.O. Box 9941
Photocopy Unit
Stop 6734
Ogden, UT 84409

(4) Medical Records Release Authorization

Use this form for obtaining copies of your medical records. In most circumstances, excepting independent medical exam at the request of a third party, you are absolutely entitled to obtain copies of your medical records.

Call us for a no-obligation initial telephone consultation.

Client Reviews
"Injury At Sea knows the maritime business from all angles…easy to work with, hardworking, straightforward, and professional. I was treated with care and concern. They were very helpful in my situation, told me exactly what to do, what to expect and the likely outcome. Five Stars." Chris, of Orcas Island
"...when they said they would not give John a liver transplant, my heart sank...for the first time in my life I hated being poor because I could not save my child...there was nothing I could do...When I was told Injury At Sea had obtained a Court Order to make the Company pay I cried tears of relief...without this my son would have had no hope of living...Thank you to Injury At Sea..." Mary
"Easy to work with, thorough and effective. Knows the maritime injury business from all angles including his own work experience. Tom was easy to work with, hard working, straightforward, and professional. I was treated with care and concern. He was very helpful in my situation, told me exactly what he could do, what to expect and the likely outcome." Chris