Tcpa Intake Form - Levi & Korsinsky, LLPLevi & Korsinsky, LLP

What are you receiving? (Select all that apply)

Robocalls / recorded voice ('press 1' menus, dead air) Spam or marketing texts I never signed up for Calls or texts that continued after I said stop / replied STOP Repeated calls for someone else (wrong number)

Who is contacting you, if known? (Company name, or the phone number(s) if not)

Are the calls or texts coming to your cell phone?

Yes, my cell phone A landline Both

Roughly how many of these calls or texts have you received?

When did these calls or texts start?

Did you ever tell them to stop (replied STOP, asked them to quit calling, or revoked consent)?

Yes – and they kept contacting me Yes – and they stopped No, I haven't

Is your number on the National Do Not Call Registry (donotcall.gov)?

Yes No Not sure

Do you still have the calls or texts on your phone? (Select all that apply)

Call history with the numbers The text messages Saved voicemails I deleted most of it

Please upload screenshots of the calls or texts, or a saved voicemail, showing the numbers and dates. (You can add more later.)

How did you hear about us?

Do you consent to text messages (so our law firm can communicate with you)?

Yes No

First Name

Last Name

City of residence?

What's the best email address for you?

What's the best phone number for you?

State

ROBOCALLS & SPAM TEXTS

All Set!

Thank You!

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