What is the average dollar amount of your claim(s)? * Claim amount Less than $7,500 $7,501 - $25,000 $25,001 - $50,000 $50,001 - $100,000 $100,001 - $250,000 $200,001 - $500,000 $500,000 +
Which of the following best describes your claim? * Select claim type You lent money or extended credit You are owed money from another party You provided services to another party and were not paid (or not paid in full) You are owed money for unemployment You provided goods to another party and were not paid (or not paid in full) You are owed past due rent from an evicted tenant (but not an eviction) You are owed services that were not performed You are owed goods that were not delivered You were provided with less than satisfactory service You were provided with less than satisfactory goods You have an unpaid promissory note None of the above
What is your company’s Industry? * Select industry Financial Services Factoring Manufacturing Retail Distribution Insurance Real Estate Leasing Other
What is the jurisdiction/state of law recognized within your contract? Select state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -- Territories and Affiliated Jurisdictions -- Guam - Guam Code, Govt. Site, 48 U.S.C. Ch. 8A Northern Mariana Islands - Comprehensive Law Site, 48 U.S.C. Ch. 17 Puerto Rico - Constitution , 48 U.S.C. Ch. 4 U.S. Virgin Islands - Govt. Site, 48 U.S.C. Ch. 7, 48 U.S.C. Ch. 12
