Case Evaluation Form
It is important that you enter all of your information below and answer all of the questions to the best of your ability, so that we get a clear picture of your situation, evaluate your case and make an accurate determination of your case potential. Once we have reviewed your information, a member of Loss Recovery Center will get back to you shortly. If you have any questions, call us at: 1-877 466-2722. Once you have filled out this form, please fax this form to: (775) 201-1233
Name
Company Name
Address
City
State
Zip
Home Phone
Business Phone
Fax Number
(circle one)
1. Was the money you lost meant for your retirement?
Yes No Unknown
2. Did you tell your broker you could not lose any principle?
Yes No Unknown
3. Did your broker, in essence, "guarantee" that the investment was right for you and that you could not lose?
Yes No Unknown
4. Did you feel pressure to act fast when you made your investment?
Yes No Unknown
5. Were you asked to sign any papers without reading them?
Yes No Unknown
6. Do you think your broker concealed information from you about his experience and skill or about the investment?
Yes No Unknown
7. Did you realize after the fact that your advisor had not explained the true nature of the investment to you?
Yes No Unknown
8. Did you lack sufficient educational background, specifically knowledge regarding investments, to understand the investment when you entered into the transaction?
Yes No Unknown
9. Did you lack sufficient financial resources (risk capital) to support the investment?
Yes No Unknown
10. Did your broker lie to you or misrepresent the investment?
Yes No Unknown
Loss Recovery Center, Inc.
10425 Double R Boulevard, Suite 500, Reno, NV 89523
1-877 466-2722 / Fax: (775) 201-1233
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NASAC, a subsidiary of Loss Recovery Center