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
PACS Shares purchased
*
Estimated total losses
*
Shares purchased during the Relevant Period
Range of losses
*
$0-$49,999
$50,000+
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
How did you hear about our case?
Please list the date, quantity and share price of your purchases/sales during the Relevant Period so that we can calculate your losses.
*
Upload your trade information.
Browse Files
Cancel
of
Send me text messages about this investigation.
Send me text updates about new investigations and other cases.
Send me emails about this investigation.
Send me emails about new investigations and other cases.
Submit
Should be Empty: