Lead Intake Form

First Name

Middle Name

Last Name

Previous / Maiden Name(s)

Current Address

Street Address

City

State

Zip Code

Previous Address(es)

Phone Number

Email Address

What type of potential claim are you contacting us about?

State

County

Property Address Associated With the Potential Claim

Street Address

City

State

Zip Code

Were you the property owner associated with this potential claim?

When did the sale, foreclosure, tax sale, or other event approximately occur?

Do you know the approximate date of the sale or foreclosure?

Do you have any information about the potential claim?

Claim or Reference Information

Upload Supporting Documents

You may upload documents related to the potential claim, such as: Foreclosure notices / Tax sale notices / Court documents / Government letters / Claim notices / Property records / Other documents related to the potential claim.

How did you hear about Civic Reclaim Partners?

If you were referred to us, who referred you?

Is there anything else you would like us to know about your potential claim?