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Request for Assistance: Congressman Patrick McHenry: NC 10


You can complete this form and send it to me electronically by clicking the “Send” button below. If you prefer, you can print this form and mail or fax it to me at:
P.O. Box 1830, Hickory, NC 28603
Fax: 828.327.8311

(Reminder: You will also need to mail, fax or scan an accompanying Authorization Form. To get a printable authorization form click here. If you are not able to print an Authorization Form, check the option above the send button that asks if you need an authorization form. I will mail a form to you.)
Date:
Month Day Year  
Name:
Prefix
First
Middle
Last
 Suffix
Mailing Address:
 
City
 State Zipcode 4 digit ext.
County of Residence:
Home Telephone:
Work Telephone:
Email:
Date of Birth:
Month Day Year  
Agency or Agencies involved:
Case ID (VA claim, Alien number, tax ID, Social Security, etc.):
Date Claim was Filed:
Place Claim was Filed:
Please Describe Problem in Detail:
Click here if you need an authorization form sent to you
 
  District Office: P.O. Box 1830, 87 4th St. NW Suite A, Hickory, NC 28603 Telephone: 828.327.6100 Fax: 828.327.8311
DC Office: 224 Cannon House Office Building, Washington, D.C. 20515 Telephone: 202.225.2576 Fax: 202.225.0316