Consumer Action Assist

First Name

Last Name

Phone Number

Email Address

Were you or a loved one diagnosed with any of the following cancers?

Did your loved one pass away within the last 10 years while using roundup?

Have you or a loved one used Roundup for at least one year or more on a commercial or residential property and for how many years?

Yes, 1 Year
Yes, 2 Years or More
No, less than 1 year

Did you or a loved one use Roundup Before or After Jan 1st, 2000?

After Jan 1st, 2000
Before Jan 1st, 2000
Both

Do you currently have an attorney for this case?

Yes No

Briefly describe what happened.

`By clicking "Check Eligibility" and providing your phone number and email you consent to our Terms & Conditions and Privacy Policy. You provide express written consent for Consumer Action Assist™, its Marketing Partners, and their affiliates to contact you about Offers via live agents, automated systems, texts, and emails, even if your number is on a National or State Do Not Call list. This consent isn't a condition of any purchase. Msg and data rates may apply. Opt-out anytime by replying STOP.`