Carl Levin - United States Senator for Michigan: Helping You

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Once you have reviewed your information on the next page, press the Print and Submit button. This will generate a PDF containing all of the information you have entered as well as a privacy release form. Please print the form, sign and date the last page, and return the form in its entirety to my Detroit office by fax or mail.

Although the information on your form will be submitted to my office electronically, we cannot open an inquiry on your behalf until we receive your signed form.

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Primary Contact Info - Preview

Salutation *

First Name *

Middle Name

Last Name *

Suffix

Street Address *

Street Address (2)

City *

State *

Zip Code *

Primary Phone *

Secondary Phone

e-mail

Federal Agency Information - Preview

Federal Agency Involved *

With which office is your claim pending?

Contacted another congressional office?*

Description of Request - Preview

Description
(please describe the problem in as much detail as necessary)

Preview and Send Request

Please review the information on this page. If you need to make any changes, click on the Edit button to return to the previous page.

To submit your request to my office, press the Print and Submit button. This will generate a PDF containing all of the information you have entered as well as a privacy release form. Please print the form, sign and date the last page, and return the form in its entirety to my Detroit office by fax or mail.

Although the information on your form will be submitted to my office electronically, we cannot open an inquiry on your behalf until we receive your signed form.

Edit

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Thank you for contacting me. The information on your form has been submitted electronically to my office. A PDF of your form is being generated automatically and should be ready within 10 seconds. If one is not available to download in that time, click here.

Once we have received your signed authorization, my staff will begin assessing how we can help. Please allow up to 30 days from the day we receive your release for my office to contact you. Thank you.