myautoaccidentclaim.com
Open in
urlscan Pro
13.224.189.128
Public Scan
Submitted URL: https://www.myautoaccidentclaim.com/
Effective URL: https://myautoaccidentclaim.com/
Submission: On November 12 via automatic, source certstream-suspicious — Scanned from DE
Effective URL: https://myautoaccidentclaim.com/
Submission: On November 12 via automatic, source certstream-suspicious — Scanned from DE
Form analysis
1 forms found in the DOMName: email-form — POST ./thankyou/
<form id="email-form" name="email-form" data-name="Email Form" method="post" action="./thankyou/" class="form shadow-lg bg-gray-50 md:max-w-xl md:mx-auto rounded-lg sm:overflow-hidden border-t-8 border-blue-700">
<div class="">
<h3 class="text-xl font-extrabold text-center mt-4 text-blue-700"> Get Your 100% FREE Case Review <svg class="inline-block w-6 h-6 relative bottom-1" fill="currentColor" viewBox="0 0 20 20" xmlns="http://www.w3.org/2000/svg">
<path fill-rule="evenodd" d="M16.707 10.293a1 1 0 010 1.414l-6 6a1 1 0 01-1.414 0l-6-6a1 1 0 111.414-1.414L9 14.586V3a1 1 0 012 0v11.586l4.293-4.293a1 1 0 011.414 0z" clip-rule="evenodd"></path>
</svg>
</h3>
<div class="mt-8 px-3 sm:text-left">
<div class="mt-4">
<div class="mt-4">
<label for="suffer_abuse" class="block text-sm font-medium leading-5 text-gray-700"> How bad was your car accident? </label>
<div class="mt-1 rounded-md shadow-sm">
<select id="suffer_abuse" name="suffer_abuse" data-name="suffer_abuse" required="" class="form-select block w-full transition duration-150 ease-in-out sm:text-sm sm:leading-5">
<option value="" disabled="" selected="">-- Select --</option>
<option value="I was injured">I was injured</option>
<option value="I was not injured at all">I was not injured at all</option>
</select>
</div>
</div>
<div class="mt-4">
<label for="attorney" class="block text-sm font-medium leading-5 text-gray-700"> Are you currently represented by a lawyer for the accident? </label>
<div class="mt-1 rounded-md shadow-sm">
<select id="attorney" name="attorney" data-name="attorney" required="" class="form-select block w-full transition duration-150 ease-in-out sm:text-sm sm:leading-5">
<option value="" disabled="" selected="">-- Select --</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</div>
</div>
<div class="mt-4">
<label for="abuse_type" class="block text-sm font-medium leading-5 text-gray-700"> Are you at fault for the accident? </label>
<div class="mt-1 rounded-md shadow-sm">
<select id="abuse_type" name="abuse_type" data-name="abuse_type" required="" class="form-select block w-full transition duration-150 ease-in-out sm:text-sm sm:leading-5">
<option value="" disabled="" selected="">-- Select --</option>
<option value="No I am not at fault">No I am not at fault</option>
<option value="Yes it was my fault">Yes it was my fault</option>
<option value="There was no one else there">There was no one else there</option>
<option value="I hit an animal/ditch/tree">I hit an animal/ditch/tree</option>
<option value="Had a mechanical problem">Had a mechanical problem</option>
<option value="None of the above">None of the above</option>
</select>
</div>
</div>
<div class="mt-4">
<label for="date_accident" class="block text-sm font-medium leading-5 text-gray-700"> When did the accident take place? </label>
<div class="mt-1 rounded-md shadow-sm">
<select id="date_accident" name="date_accident" data-name="date_accident" required="" class="form-select block w-full transition duration-150 ease-in-out sm:text-sm sm:leading-5">
<option value="" disabled="" selected="">-- Select --</option>
<option value="Within the last year">Within the last year</option>
<option value="1-2 years ago">1-2 years ago</option>
<option value="More than 2 years ago">More than 2 years ago</option>
</select>
</div>
</div>
<div class="flex flex-col sm:flex-row justify-between">
<div class="mt-4 w-full md:w-1/2 md:pr-3">
<label for="first_name" class="block text-sm font-medium leading-5 text-gray-700"> First Name </label>
<div class="mt-1 rounded-md shadow-sm">
<input class="form-input block w-full transition duration-150 ease-in-out sm:text-sm sm:leading-5" id="first_name" type="text" maxlength="256" name="first_name" data-name="first_name" required="" value="">
</div>
</div>
<div class="mt-4 w-full md:w-1/2 md:pl-3">
<label for="last_name" class="block text-sm font-medium leading-5 text-gray-700"> Last Name </label>
<div class="mt-1 rounded-md shadow-sm">
<input class="form-input block w-full transition duration-150 ease-in-out sm:text-sm sm:leading-5" id="last_name" type="text" maxlength="256" name="last_name" data-name="last_name" required="" value="">
</div>
</div>
</div>
<div class="mt-4">
<label for="email_address" class="block text-sm font-medium leading-5 text-gray-700"> Email Address </label>
<div class="mt-1 rounded-md shadow-sm">
<input id="email_address" name="email_address" data-name="email_address" type="email" required="" pattern="[^@\s]+@[^@\s]+\.[^@\s]+" class="form-input block w-full transition duration-150 ease-in-out sm:text-sm sm:leading-5" value="">
</div>
</div>
<div class="flex flex-col sm:flex-row justify-between">
<div class="mt-4 w-full md:w-1/2 md:pr-3">
<label for="phone_home" class="block text-sm font-medium leading-5 text-gray-700"> Phone Number </label>
<div class="mt-1 rounded-md shadow-sm">
<input class="form-input block w-full transition duration-150 ease-in-out sm:text-sm sm:leading-5" type="tel" maxlength="256" name="phone_home" data-name="Phone" id="phone" required="" value="" inputmode="text">
</div>
</div>
<div class="mt-4 w-full md:w-1/2 md:pl-3">
<label for="zip" class="block text-sm font-medium leading-5 text-gray-700"> Zip Code </label>
<div class="mt-1 rounded-md shadow-sm">
<input id="zip" name="zip_code" data-name="zip_code" type="tel" pattern="^\D*(\d\D*){5,}$" required="" class="form-input block w-full transition duration-150 ease-in-out sm:text-sm sm:leading-5" value="" inputmode="text">
</div>
</div>
</div>
<div class="mt-4">
<label for="description" class="block text-sm font-medium leading-5 text-gray-700"> Describe the accident. What happened? </label>
<div class="mt-1 rounded-md shadow-sm">
<textarea name="description" id="description" class="form-input block w-full transition duration-150 ease-in-out sm:text-sm sm:leading-5 form-textarea"></textarea>
</div>
</div>
</div>
</div>
</div>
<div class="text-xs px-3 pb-3 text-left mt-4">
<p class="sub just">
<label for="leadid_tcpa_disclosure" class="sub">
<input type="checkbox" name="tcpa_consent" value="Yes" id="leadid_tcpa_disclosure" required=""> <span class="desktoponly">By checking this box and clicking the "Agree and Submit" button below, I confirm that I am 18 years of age
or older and have read and agreed to the National Injury Bureau <a href="/terms-of-service/">Terms and Conditions</a> and <a href="/privacy-policy/">Privacy Policy</a>. I consent to the transfer of my information to third-party legal and
non-legal service providers, marketing partners, their affiliates, and service providers. I agree to be contacted for marketing purposes via email, phone calls (which may include artificial or pre-recorded messages), and SMS text messages
using automated technology, to the contact information I have provided. I understand that my consent is not a condition of receiving services. For more information, please visit our <a href="/marketing-partners/">Marketing Partners</a>
page.</span>
<span class="mobileonly" style="font-weight:bold">I agree to the terms below.</span>
<input type="submit" value="AGREE AND SUBMIT →" data-wait="Please wait..." class="text-shadow-green bg-green block w-full mx-auto text-white font-bold border-0 rounded cursor-pointer py-4 px-2 m-4 submitBtn">
<span class="mobileonly">By checking this box and clicking the "Agree and Submit" button below, I confirm that I am 18 years of age or older and have read and agreed to the National Injury Bureau
<a href="/terms-of-service/">Terms and Conditions</a> and <a href="/privacy-policy/">Privacy Policy</a>. I consent to the transfer of my information to third-party legal and non-legal service providers, marketing partners, their affiliates,
and service providers. I agree to be contacted for marketing purposes via email, phone calls (which may include artificial or pre-recorded messages), and SMS text messages using automated technology, to the contact information I have
provided. I understand that my consent is not a condition of receiving services. For more information, please visit our <a href="/marketing-partners/">Marketing Partners</a> page.</span>
</label>
</p>
</div>
<input id="leadid_token" name="jornaya_lead_id" type="hidden" value="23D36455-8B38-36B0-3BA3-42202B931EB1">
<input type="hidden" name="page_version" value="MVA Split">
<input type="hidden" name="trusted_form_cert_id" value="https://cert.trustedform.com/41b99f937b69f7a994ea1245ed30048dd99d06e8" id="trusted_form_cert_id_0"><input type="hidden" name="xxTrustedFormToken"
value="https://cert.trustedform.com/41b99f937b69f7a994ea1245ed30048dd99d06e8" id="xxTrustedFormToken_0"><input type="hidden" name="xxTrustedFormPingUrl"
value="https://ping.trustedform.com/0.yErN8h4q84a6PNt63q6QLSLE0zaBdlqlYjDhbZS5vGi3v_4GO7KDvapWnklic85HwgubKjQ.FcvGoGRGxZhmRjHpbdVE4w.2bph1vjMqRgF_kt7Ud1sqA" id="xxTrustedFormPingUrl_0">
</form>
Text Content
INJURED IN A CAR CRASH? WE'RE HERE TO HELP YOU! YOU DESERVE JUSTICE AND WE MAY BE ABLE TO HELP YOU MAXIMIZE YOUR INJURY COMPENSATION. WHAT'S YOUR CASE WORTH? GET YOUR 100% FREE CASE REVIEW How bad was your car accident? -- Select -- I was injured I was not injured at all Are you currently represented by a lawyer for the accident? -- Select -- Yes No Are you at fault for the accident? -- Select -- No I am not at fault Yes it was my fault There was no one else there I hit an animal/ditch/tree Had a mechanical problem None of the above When did the accident take place? -- Select -- Within the last year 1-2 years ago More than 2 years ago First Name Last Name Email Address Phone Number Zip Code Describe the accident. What happened? By checking this box and clicking the "Agree and Submit" button below, I confirm that I am 18 years of age or older and have read and agreed to the National Injury Bureau Terms and Conditions and Privacy Policy. I consent to the transfer of my information to third-party legal and non-legal service providers, marketing partners, their affiliates, and service providers. I agree to be contacted for marketing purposes via email, phone calls (which may include artificial or pre-recorded messages), and SMS text messages using automated technology, to the contact information I have provided. I understand that my consent is not a condition of receiving services. For more information, please visit our Marketing Partners page. I agree to the terms below. By checking this box and clicking the "Agree and Submit" button below, I confirm that I am 18 years of age or older and have read and agreed to the National Injury Bureau Terms and Conditions and Privacy Policy. I consent to the transfer of my information to third-party legal and non-legal service providers, marketing partners, their affiliates, and service providers. I agree to be contacted for marketing purposes via email, phone calls (which may include artificial or pre-recorded messages), and SMS text messages using automated technology, to the contact information I have provided. I understand that my consent is not a condition of receiving services. For more information, please visit our Marketing Partners page. INJURED IN A CAR, TRUCK, OR MOTORCYCLE ACCIDENT IN THE LAST YEAR THROUGH NO FAULT OF YOUR OWN? 1000s of people are injured in these accidents every day and most have injuries that deserve compensation. The injuries sustained in these collisions can range from bruises, sprains, broken bones, catastrophic brain and spinal injuries... to death. Yet insurance companies try to settle claims quickly and not pay the proper amount- even when the law says you may be owed thousands for your medical bills and pain and suffering. Do you qualify for compensation? Don't suffer in silence. Let our experienced team of Accident Attorneys secure you the help you deserve- at no cost to you. We don't get paid until you win your case. Click the button below to take our 15-second 100% confidential survey and discover what your case is worth: Start Your Free Case Review TICK TOCK: ACT NOW BEFORE TIME RUNS OUT ON YOUR CASE There is a statute of limitations on how long you can wait before making a claim for a motor vehicle accident. If you were injured in a motor vehicle accident and less than 1 year has passed, there's no better time to claim your free Case Review than now. You may qualify for compensation for lost wages, medical bills, property damage, and pain & suffering. Yet the time for you to take action is limited. Click the button below for your 100% confidential free case review & see what your case is worth: Take 15 Second Case Review YOU MAY BE ELIGIBLE FOR CASH COMPENSATION IF: You were over the age of 18 when the motor vehicle accident took place. You were not at fault and did not cause the accident. You have documentation (including photo/video evidence, police reports, medical reports, auto repair estimates etc) You currently do not have legal representation. Take This 100% Free 15-Second Survey See if You Qualify If you've been injured in a motor vehicle, the physical injuries & emotional trauma can take years to heal. Our advice? Stop suffering in silence and seek the justice you deserve. 15 Second Case Review HOW TO IMPROVE YOUR CHANCES OF MAXIMIZING YOUR COMPENSATION You may increase the odds of receiving fair compensation if you have video/photo evidence of the following: 1. Your Injuries This includes photos of your injuries after the incident and during the days/weeks that pass while you recover. Medical records, x-rays, prescription medication receipt and other expenses should also be preserved. 2. The Accident Location We recommended that you take photos and videos of your vehicle and the entire accident scene. This can include traffic lights and signs, weather conditions, road damage, sun glare, or other mitigating conditions. This may provide useful context to protect your claim. 3. Vehicle Damage Photo/video evidence can paint a compelling picture of how the accident happened and who was at fault. Be sure to capture damage on the exterior and interior of your vehicle, along with any damage to your property. WORK WITH OUR VETERAN ATTORNEYS Anyone who has been injured in a motor vehicle, trucking, bike, or pedestrian accident in the last 1 year may be able to file a lawsuit and seek justice, including financial compensation for your pain and suffering. See if You Qualify Copyright © 2024 MyAutoAccidentClaim.com- All Rights Reserved. Terms of Service | Privacy Policy | CCPA Notice | Do Not Sell My Info | Accessible View | Contact Us Advertising paid for by participating attorneys in a joint advertising program, including Kevin Danesh, licensed to practice law only in California. A complete list of joint advertising attorneys can be found at our sponsors link. You can request an attorney by name. This Website is a group advertisement. It is not a lawyer referral service. MyAutoAccidentClaim.com is owned and operated by National Injury BureauTM and is not a law firm. We connect people to legal service providers and there is no charge to be connected with an attorney. You are under no obligation to retain any services of those connected through our website. We try our best to keep things fair and balanced to help you make the best choice for you. This information does not constitute legal or medical advice and it should not be relied upon as such. Results are not guaranteed and past performance is not an indication of future success. Always consult with your doctor before modifying your medication or regular medical regimen.