653 W. Skippack Pike
Suite 300-71
Blue Bell, PA 1942
2
Telephone: (215) 278-6564
Toll Free: (855) 978-6564
Fax: (855) 777-0043
www.ginsburglawgroup.com
Please provide answers to the following questions.
If you need help completing this form, please feel free to contact us at 215-278-6564 or toll free at 855-978-6564.
Privacy Policy
All information received from a client is strictly confidential. Our firm takes every step possible to protect your privacy.
Your personal information will only be used in the event that you hire the firm to represent you in your legal matter, and then only when necessary in limited use during the course of your case.
If you have any questions, please don't hesitate to contact our law office. We look forward to working with you!
Your Information
Let's get the basics out of the way! Please provide us with the information requested below.
Contact information
Prefix
First name
*
Middle name
Last name
*
Date of birth
Company
Emails
Address
*
Type
Upon submission, a copy of this form will be sent to the primary email.
Work
Home
Other
Primary
Default email false
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Addresses
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Australia
Canada
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---------------
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Phone numbers
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You may change your telephone number or move and forget to tell us! Please provide us with the name, address and phone number of an emergency contact that we can reach out to if we are unable to reach you. We will always try to reach you first at the contact information provided above.
YOUR PHONE
Now that we know who you are, we want to find out more information about where you were contacted. This includes questions about the number you received calls on, who uses this phone, what type of phone line you are using, and your carrier.
What types of contacts are/were you receiving?
Text Messages
Phone Calls
Voice Messages
Were the calls/texts made to your cellular telephone?
Yes
Who is your cellular telephone provider?
No
What type of line were the calls received on (i.e. home, business, etc.)?
What is the telephone number you received calls on?
Who is the primary user of the telephone number that calls/texts were received on?
I am
Another Family Member
Identify family member (name and relationship to you):
Other
Identify this person (name and relationship to you):
Is this telephone number included on the do not call registry?
Yes
If yes, please include the date this number was added to the DNC registry. If more than one number, note the number next to the date.
No
The Offending Company
Thanks for filling us in on the device you used. Next we want to know who was contacting you!
Please provide the name and address of the company contacting you.
Please list all phone numbers or short code used by the company to contact you.
Does the company have a website?
Yes
What is the website?
No
Please fill us in on any research you did on this company:
Do you have or did you have a business relationship with this company?
Yes
If yes, describe.
No
Did you give permission to this company (or any related business) to contact you? For example, you may have visited their website, entered a sweepstakes, or opened an account.
Yes
If yes, please describe.
No
The Communications
Next we want to know more about when you received the calls/texts, why they were contacting you, and what was communicated. Don't worry, we are almost done!
When did the communications first begin?
What was the date of the most recent communication?
What was the purpose of the calls/texts?
Debt collection
Marketing/Solicitation
What were they trying to market/solicit?
Other
Please describe the purpose of the communications.
How frequent were the calls/texts?
Multiple times a day
At least once a day
A few times a week
A few times a month
Don't recall
If known, please provide the dates/times of the text messages or calls:
Please describe the communications you had with any individuals from this company.
Please provide the names of any individuals you recall communicating with during these calls/texts:
Did you ever tell them to stop calling/texting you?
Yes
When did you tell them to stop?
No
How many total calls/texts did you receive from this company?
Do you believe the calls and/or texts were automated or computer generated?
Yes
Please describe why you believe they were automated or computer generated:
No
Have you ever answered the phone and there was a noticeable pause or delay before someone came on the line to talk to you?
Yes
No
If you received calls, did they include a pre-recorded or automated message?
Yes
Describe the recording(s) or message(s) received:
No
Not Applicable
Do you have any images of the calls/texts you received?
Yes
Please attach any images.
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No
Do you have any letters/emails from this company?
Yes
If yes, please attach.
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No
Do you have any recordings of the communications?
Yes
If yes, please attach.
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No
Is there anything else you would like to share about the communications?
Please upload any additional documents you have related to your case. You can also fax these documents to 215-278-9059 or 855-777-0043.
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Final Questions
Just a few more and we are all done!
Please describe any out of pocket losses you had related to these communications.
Have you ever filed a case against someone for harassing telephone calls or robocalls in the past?
Yes
If yes, please describe.
No
Have you ever filed for bankruptcy?
Yes
If yes, please state when you filed, where you filed, and the status of your bankruptcy.
No
How did you hear about our firm?
Online
On what site?
Word of Mouth / Referral
Who can we thank for referring you?
Other
Please share where you heard about us.
Please identify the name of the person who completed this form.
Acknowledgement and Acceptance
I acknowledge that I have read and hereby accept the above privacy policy regarding use of my personal information.
That is it!
Please click
SUBMIT
below.
We will review this information and be in touch soon!
In the meantime, please feel free to contact us with any questions at 215-278-6564 or toll free at 855-978-6564.