Roundup Intake Form

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If you or your family member were exposed to Roundup and have non-Hodgkin’s lymphoma, you may have a claim against Roundup’s maker, Monsanto, for an award of monetary compensation.
For a free consultation with our firm about your claim, please answer the questions in the form below.
All your communications with us will be strictly confidential. You do not have to pay at any point for the consultation.
If we represent you, we will work on a contingency fee basis, which means that you will not owe any fees or costs unless you receive a financial recovery for your claim.

Roundup intake form

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Are you bringing this claim for yourself, or on behalf of a family member?

If you are bringing this claim on behalf of a family member, please state their name, and their relationship to you.

Non-Hodgkin’s Lymphoma.

When were you or your family member diagnosed with Non-Hodgkin’s Lymphoma?

Exposure to Roundup.

Did you or your family member work on a farm that may have used Roundup? If so, when and where?

Were you or your family member exposed to Roundup in any other way? If so, please explain:

Dovel & Luner, LLP may text me regarding my submission. Message & data rates may apply. Message frequency varies. Unsubscribe at any time by texting STOP.