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Attorney Name: *
Phone: *
Email: * (will be kept private)
Law Firm Name:
Website Address:
Desired Membership Level: * Select One Silver Level: ≥ $500,000 Gold Level: ≥ $1,000,000 Platinum Level: ≥ $10,000,000 Diamond Level: ≥ $50,000,000
Street Address: *
City, State: *
Zip Code: *
Law School:
Year of Graduation:
State Bar Member in Good Standing? * Yes
Personal Injury
Wrongful Death
Auto Accidents
Truck Accidents
Work Accidents
Premises Liability
Medical Malpractice
Products Liability
Drug Injuries
Maritime Law
Patent and Trademark
Copyright Law
Civil Rights
Libel / Slander
Bad Faith Insurance
Dram Shop Law
Class Action Lawsuits
Consumer Law
Entertainment Law
Intellectual Property
Nursing Home Abuse
Sports Law
Real Estate Law
Business Law
About the Attorney:
About Your Business:
Type of Recovery: Trial Verdict
Final Settlement
Arbitration Award
Total Recovery Amount:
Please include as much information as you can, such as: case name, client name, nature of the case, court & docket #...
If you have additional recoveries that you would like to put toward your total recovery amount, please include them in an email to us by clicking here.
Total Amount of All Above Recoveries: *(include any additional emailed recoveries)
For lifetime membership into SuccessfulVerdicts, there is a 1-time fee of $475 $399 (limited time offer). This may be paid online through PayPal, or you may pay by mail with a check or money order. (Note: You don't have to join PayPal to do this; you can do it as a one-time thing.)
Payment Method: *
Check or Money Order by Mail
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