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The purpose of this form is to allow us to gather information regarding the advertising and sales practices used by the company listed above, as they relate to the wireless vehicle back-up camera system product, and to expand our information regarding witnesses and potential class members.

Items marked with an * are required information in order for us to respond.

First Name: *
Last Name: *
Mailing Address:
City:
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Phone Number:
E-mail Address: *

IMPORTANT INFORMATION AND DISCLAIMER: Reading this website and filling out this form does not constitute legal advice or a request for legal advice, nor does it constitute or guarantee representation by the Jones Bell, nor guarantee membership in a class if and when one is established. An attorney-client relationship is not created by visiting this website or by submitting the informational form that follows.

* YES, I have read this “Important Information and Disclaimer,” and understand and agree that I am not requesting or receiving legal advice and am not entering into an attorney-client relationship.