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Defendant's Information
Defendant's Company Name
Defendant's First Name
Defendant's Last Name
Defendant's Email Address
Defendant's Address (enter mailing address)
Defendant's Office Phone
Defendant's Cell Phone
Defendant's Home Phone
Defendant's License Number
Defendant's EIN or SSN
Defendant's Website
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Plaintiff's First Name
Plaintiff's Middle Name
Plaintiff's Last Name
Plaintiff's Address (enter mailing address)
Plaintiff's Email Address
Plaintiff's Home Phone
Plaintiff's Cell Phone
Plaintiff's Work Phone
Information about where Unethical & Illegal actions occured
Complaint Category
County
Description For Legal Review (please be as detailed as possible)
City
State
Suggested Strategy (for the legal and media department's at BlackListNow)