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13
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1
What Is Your Business Name
*
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2
Number of Employees
*
This field is required.
Max 100 Employees
0 - 10
11 - 50
51 - 100
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3
Primary State Your Business Is Located
*
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AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
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4
How Long Have You Been Running Your Business?
*
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Not Started
0 - 2
2 - 10
Over 10 Years
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5
What's The Annual Revenue Of Your Business?
*
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Less Than $25K
$25K - $100K
$100K - $1M
Over $1M
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6
What Type Of Legal Help Does Your Business Need?
*
This field is required.
Select all that apply.
Legal Advice
Contract Review
Contract Drafting
Collections
Other Needs
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7
Could Your Business Improve Its Debt Collection Success Rate If Collection Letters Were Written By A Quality Law Firm Using Their Letterhead?
*
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YES
NO
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8
How Many Debt Collection Letters Would You Need To Send Each Month?
*
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9
Are You Concerned That Your Business May Need Trial Defense Protection During The Next Year?
*
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This includes Pre-Trial Proceedings
YES
NO
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10
Name
*
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First Name
Last Name
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11
Email
*
This field is required.
example@example.com
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12
What's The Best Number To Reach Your At?
*
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Area Code
Phone Number
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13
Book Your Appointment To See If Your Business Qualifies
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