Your Name: (required)
Your Position: (required)
Your E-Mail: (required)
Telephone Number: (required)
Your Company Name: (required)
This Matter is: (select one) (required) ConsumerCommercial
Location of Debtor:
Is there a Written Agreement Between the Parties? YesNo
Average Size of Debt Balance:
Preferred Billing Structure HourlyContingency Fee
Industry/Business Type:
Your Company Size:
Annual Business Revenue Range: 1-2 million2-5 million5+ million
Type of Referral: Single ReferralMultiple ReferralsOther
Any addition information regarding your debtor(s):
* Please do not include any confidential or sensitive information in your E-Mail or in the Contact Form. The Contact Form sends information by non-encrypted e-mail which is not secure. Due to the nature of the Internet, the Contact Form or your E-Mail may not be received by this office. Therefore, please do not rely on the submission of the Contact Form or your E-Mail. Also, by sending an E-Mail, or submitting the Contact Form, no Attorney-Client relationship is formed with Spiwak & Iezza, LLP or its attorneys.
Your Name
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