TLS - Backpage Remission Program Eligibility Intake

Backpage Remission Program

Client Eligibility Intake Form. Claim Filing Deadline: March 31, 2026
Eligibility Screening

*Fields marked with * are required
1. Were you advertised on Backpage.com or CityXGuide.com for commercial sex-work induced by force, fraud, or coercion between 1/1/2004 - June 19, 2020? (If No, you are not eligible for this program. Thank you for your interest.)*

YesNoUnsure
2. If yes, which platform(s)?*

Backpage.com (January 1, 2004 – April 6, 2018)CityXGuide.com (April 8, 2018 – June 19, 2020)Both
3. Are you filing this petition form on behalf of a minor, an incapacitated individual, or an estate as a Personal Representative?

MinorIncapacitated IndividualAn estate as a Personal RepresentativeSelf
4. Relationship to Victim

MinorIncapacitated IndividualDeceasedSelf
Contact Information

*Fields marked with * are required
Full Legal Name:*

First NameMiddle NameLast Name
Other Names Used:
(aliases, maiden name, etc.)
Date of Birth:*

MonthDayYear
Date
Cell Phone Number:*
Please enter a valid phone number.
Email Address:*
example@example.com
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Contact Method:*

PhoneEmailText
Additional Information

*Fields marked with * are required
3. Stay connected with The Law Shed.*

Yes, I would like to receive updates, newsletters, and information about other settlements and legal services from The Law Shed. I understand this is optional and not required to participate in the Backpage Remission Program.No
4. Is there anything else you would like us to know?
Attorney Advertising Disclaimer
1. This information is provided by T.K. Sheth Law LLC d/b/a The Law Shed, an independent law firm assisting participants in the Backpage Remission Program.
2. Petitioners are not required to retain legal counsel. Free assistance is available from the Remission Administrator at www.backpageremission.com and through the Backpage Survivor Remission Network at www.backpageremissionnetwork.org.
3. Submitting a petition does not guarantee payment. Eligibility and payment amount are determined solely by the DOJ and Remission Administrator.
4. All information provided will be used solely for petition processing and is protected under applicable confidentiality laws and rules of professional responsibility.
5. No attorney-client relationship is formed unless and until a written engagement agreement is executed by both parties.
6. This material constitutes attorney advertising. Prior results do not guarantee future outcomes.
7. Attorney Tanvi K. Sheth is licensed in Illinois. The Law Shed's representation is limited to administrative petition filing and does not include legal advice outside Illinois unless permitted under applicable rules.
8. Fee Disclosure: Representation is on a 30% contingency fee basis. There are no upfront costs or expenses charged to the client.
Consent and Authorization: By completing and submitting this intake form, I acknowledge and agree that: I am providing my information to T.K. Sheth Law LLC d/b/a The Law Shed for the purpose of pursuing a claim in the Backpage Remission Program. I authorize The Law Shed to contact me, prepare, sign, and submit my claim form to the Claims Administrator on my behalf, and to communicate with the Claims Administrator regarding my claim. The information I have provided is true, accurate, and complete to the best of my knowledge, information, and belief. I understand that The Law Shed, and the Settlement Administrator will request additional information or documentation to support my claim, and I agree to provide it as requested and cooperate in obtaining the required documentations. I consent to be contacted by The Law Shed electronically, including by email, phone, and/or mobile text message (message & data rates may apply), regarding this claim and related representation.*

YesNo
⚖️ Engagement Reminder
Important Notice:
Completing this intake form is only the first step. In order to become a client of T.K. Sheth Law LLC d/b/a The Law Shed, you must also review and sign a separate Engagement Agreement.

No attorney-client relationship is formed until both of the following occur:

(i) You complete this intake form; and
(ii) Click to sign the Engagement Agreement.

Upon completion of this intake and engagement agreement, your submission will be reviewed by the attorney within 72 hours and the representation will be accepted or rejected.

Once you complete these submission, The Law Shed Office will contact you via phone. You will receive a call from any of these numbers:

The Law Shed Office Line: 312-219-2447

Office Email: tks@thelawshed.com & hi@thelawshed.com

Attorney Tanvi K. Sheth (cell): 847-529-8279

Paralegal Monica James (cell): 312-485-8389

Email:
The attorney will not accept representation without a completed intake form on file.
Office Use Only
Date

MonthDayYear
Date
Reviewed By:
Eligibility Determination:

EligibleNot EligibleNeeds Follow-Up
Notes:
Should be Empty:

Backpage Remission Program

Eligibility Screening

Contact Information

Additional Information

Office Use Only