First Name
*
Last Name
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Phone Number
*
-
Area Code
Phone Number
Email
*
name@domain.com
IEP Shares purchased during Class Period
*
Estimated total losses
*
Shares purchased during the Relevant Period
Range of losses
*
$0-$199,999
$200,000+
Please select
Date Contacted HB
-
Month
-
Day
Year
Date
Type of Initial contact
Web form
Email
Call
Other
HB Initial Contact
R&R Sent
R&R Returned
Cert Sent
Cert Returned
Attorney Notes:
How did you hear about this matter?
Accesswire Press Release
Business Wire Press Release
Globe Newswire Press Release
Please list the date, quantity and share price of your purchases/sales during the Relevant Period so that we can calculate your losses.
*
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