Name (required)
Email (required)
Phone (required)
Company or Individual that Caused Harm or Injury.
Product that Caused Harm or Injury
What is the nature of the harm or violation you experienced? (Please describe the issue in detail, including any physical, financial, or emotional harm.)
When did the harm or violation first occur? (Provide an approximate date or a relevant timeframe.)
Do you believe others were similarly affected? YesNoNot Sure
How many individuals do you believe might be affected?
Have you or others reported the issue to the responsible party? YesNo
When did you report the harm or injury?
How did you report the harm or injury?
Is there any evidence or documentation to support your claim? YesNo
Please briefly describe the evidence (For example, product receipts, emails, contracts, photos, or medical records.)
Have you attempted to address this matter through legal action or other processes? YesNo
Describe legal action or other processes. (identify attorney names & filing description.) --attorney name and filing description--
Are you aware of any similar claims or lawsuits regarding this situation? YesNo
Please provide details or references of similar claims or lawsuits, if known) --details or references of similar claims--
What are you hoping to achieve by pursuing this class action case? (Select all that apply): Seeks compensation for harm or violation.Hold the responsible party accountable.Prevent similar harm to yourself or others in the future.Raise awareness about this issue.Other
How do you believe this issue has impacted you personally?
Is there anything else you’d like to share regarding your situation or experience?