Register New Customer Account

complex_new_client_form

Enter your information below to get started working with us.  Step 1 is to complete the form below.  Based on the case types you select below, the last page of this form will show more information about the standard criteria for each case type, the monthly quantity demanded, and the lead type (form fill or call) demanded.

After form submission, Step 2 is to set up your payment profile.  You will NOT be charged, but we need to set up your payment profile prior to sending any leads.  Unlike other marketing companies, there is no setup fees or costs to get started with us.

Step 3 is to sign our client agreement.  After signing the client agreement and setting up both an ACH and backup credit card payment profile, we can get started working for you.


Case Requirements

Below we present the base case qualifiers for each of the mass torts selected on the previous page.  If these qualifiers are acceptable to you, select "Yes."  If you would like to customize the requirements, select "No" and a text box will show up that will allow you to customize the specific requirements and qualifying factors for that specific mass tort. 

We also ask about your quantity demand and whether you want phone calls or form fill leads.  If someone is on your staff that would manage the integration, please enter their information below also. 

Based on this information, we will provide you a customized quote based on your responses.


Roundup:

  1. Used roundup (for any length of time)
  2. Diagnosed with any cancer
  3. Does not currently have an attorney


Talcum Powder:

  1. Used talcum powder (for any length of time)
  2. Diagnosed with any cancer
  3. Does not currently have an attorney


Zantac:

  1. Used Zantac regularly for 6 months
  2. Diagnosed with any cancer
  3. Does not currently have an attorney


NEC Formula:

  1. Child diagnosed with NEC as an premature infant
  2. Used cow's milk based baby formula
  3. Does not currently have an attorney


3M Military Earplugs:

  1. Active in military between 2003 - 2015
  2. Wore dual-ended combat arms earplugs while serving in combat
  3. Suffered hearing loss, ringing ears or tinnitus
  4. Does not currently have an attorney


Hernia Mesh:

  1. Had a hernia mesh implant
  2. Had or has scheduled a hernia mesh revision surgery
  3. Does not currently have an attorney


Paragard:

  1. Had an IUD implanted
  2. Experienced breakage or fracture of the IUD
  3. Does not currently have an attorney


Elmiron:

  1. Took Elmiron
  2. Has vision problems or vision loss
  3. Does not currently have an attorney


Paraquat:

  1. Exposed to Paraquat
  2. Diagnosed with Parkinson's disease
  3. Does not currently have an attorney


CPAP:

  1. Used a CPAP or BiPAP device
  2. Diagnosed with cancer or other respiratory issue
  3. Does not currently have an attorney


Sexual Abuse:

  1. Not deceased
  2. Sexually abused as a minor
  3. Can give a description or name of the perpetrator
  4. Does not currently have an attorney


Motor Vehicle Accident:

  1. Motor vehicle accident case
  2. Not at fault for the accident
  3. Inside statute of limitations
  4. Does not currently have an attorney