Ride Share
First Name
First Name
Last Name
Last Name
Email
Email
Phone
Phone
Zip Code
Zip Code
Were you Physically Assaulted (sexual in nature) while in a Rideshare?
Yes
No
Which Rideshare Service?
Uber
Lyft
Upload receipt of ride. (.png, .jpg, .pdf)
*
Upload receipt of ride.
Upload gov.id proof (.png, .jpg, .pdf)
*
Upload gov.id proof
By clicking the "SUBMIT" button below, I affirm that I am 13 years of age or older and provide my express written consent to receive autodialed and/or prerecorded telemarketing calls and text messages from
Lawsuit Support
at the telephone number I provided above, including my wireless number, if applicable. I understand that my consent is not a condition of service and that I may revoke my consent at any time by following the opt-out instructions provided in the communications. I have also read and agree to the
Privacy Policy
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