Paraquat - FileLawsuit
First Name
First Name
Last Name
Last Name
Email
Email
Phone
Phone
Zip Code
Zip Code
Have you been exposed to Paraquat?
Yes
No
Unsure Are you an agricultural worker, landscaper, or live near a farm?
Yes
No
Did you or a loved one develop cancer or other health related issues?
Yes
No
have you been diagnosed with:
By clicking the "SUBMIT" button below, I affirm that I am 13 years of age or older and provide my express written consent to receive autodialed and/or prerecorded telemarketing calls and text messages from
FileLawsuit online
at the telephone number I provided above, including my wireless number, if applicable. I understand that my consent is not a condition of service and that I may revoke my consent at any time by following the opt-out instructions provided in the communications. I have also read and agree to the
Privacy Policy
Submit
Back
