Canoe Lead API
Personal Injury Lawyer - 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...
Assault/Battery or Sexual Abuse
Birth Injury
Brain Injuries
Construction Accident
Dangerous Product
Dog Bites/Animal Attacks
Injury At Work
Product Defect
Product Liability
Slip and Fall
Primary Injury
*
Select...
Back or Neck Pain
Brain Damage
Broken Bones
Burns
Cuts and Bruises
Headaches
Hearing Loss
Loss of Limb
Memory Loss
Other
Paralysis
Stitches
Surgery
Vision Loss
Degree of Interest
*
Select...
Absolutely can't afford
Maybe
Probably
Definitely
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
*
Date of Birth
County
Action Taken
Select...
Demand for compensation made
Lawsuit filed
No action taken yet
Other
Best Time To Call
Select...
Anytime
Morning
Daytime
Evening
Weekend
TCPA Consent
*
Select...
Yes, I consent
No
TCPA Text
*
Additional Comments
Sending post request...
Post Response
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Send Ping Request
Send Post Request