Canoe Lead API
Motor Vehicle Accident - Ping & Post Form
1
Ping Request
2
Post Request
Step 1: Ping Request
Publisher ID
*
API Campaign ID
*
Zip Code
*
Physically Injured
*
Select...
Yes
No
Were You At Fault?
*
Select...
Yes
No
Received Treatment
*
Select...
Yes
No
Has Attorney
*
Select...
Yes
No
Incident Occurred
*
Type of Injury
Select...
Bike Incident
Car Accident
Motorcycle Accident
Pedestrian Incident
Product Liability
Public Transportation Accident
Slip and Fall
Trucking Accident
Work Related Injury
Primary Injury
Select...
Anxiety
Back or Neck Pain
Broken Bones
Cuts and Bruises
Headaches
Loss of Limb
Memory Loss
Other
Landing Page URL
*
Test Mode
Test (Recommended)
Production
Sending ping request...
Ping Response
Select Bids for Post Request:
Step 2: Post Request
First Name
*
Last Name
*
Email
*
Phone
*
Address
*
Address 2
Date of Birth
County
Best Time To Call
Select...
Anytime
Morning
Daytime
Evening
Weekend
Payment Method
Select...
Cash
Check
Family
Friend
Other
Police Report Filed?
Select...
Yes
No
Business Owner?
Select...
Yes
No
Number of Employees
TCPA Consent
*
Select...
Yes, I consent
No
TCPA Text
*
Trusted Form URL
Jornaya ID
Additional Comments
Sending post request...
Post Response
Back to Ping
Send Ping Request
Send Post Request