Claim

CLAIM

Learn more about how GOIRA is able to enforce a financial resolution on your behalf.

BEFORE submitting a claim:
1) gather your files, facts, etc.
2) create a savable/editable (i.e., Google doc) with the following format:
a. Name, address, website, and phone of the individual and/or organization you're filing the claim against
b. claim details
c. what outcome you'd like to obtain
3) paste into below (submit multiple claims if more files are needed to be sent)

Submit a claim

* Indicates required field

Your name (as plaintiff) *

First

Last

Your email *

Your phone number *

This claim is against the following defendant(s): *

On a scale from one (1) to five (5), with 5 being the highest, what would you rate this individual/organization in terms of overall satisfaction? *

Claim summary *

Desired outcome *

By submitting this form, you authorize the defendant(s) to submit into mediation data and/or documents relating to this matter which may contain information about you (plaintiff). *

I authorize defendant(s) to release data/documents about me (plaintiff) into mediation

If the defendant fails to attempt to mediate, do you anticipate posting a low star rating and potentially derogatory comments to the publicly accessible major databases (i.e., Google, Bing, Yelp, BBB, Facebook, Twitter, etc.) which could negatively affect the defendant? *

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Upload File *

Max file size: 20MB

Submit

CLAIM

Submit a claim

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