First Name * Last Name * Phone Number * Email * Address * City * State * Zip *
I do not have a lawyer for this claim and am actively seeking legal help.
Year and Month You Open Your Business? *
Type of Business: *
What Date Were You Forced to Close Your Business Due to Government Orders? * 1 Month2 Months3 Months4 Months5 Months6 Months7 Months8 Months9 Months10 Months11 Months12 Months13 Months14 Months15 Months16 Months17 Months18 Months +
Annual Revenues * $50,000 - $100,000$101,000 - $249,000over $249,000
Do You Carry Business Insurance? * YesNo
Did You Submit a Claim and Get Denied? * YesNo
Confidential Comments You Would Like the Attorney to Know before We Speak: *
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