Step 1 of 4

Who is the lead?

Contact and location exactly as the lead gave them.

Contact

First name*

Last name*

Email*

Phone* US number, 10 digits

Location

City (optional)

State*

ZIP (optional)

Lead language

Step 2 of 4

About the accident

These answers decide whether the lead goes as qualified or DQ.

When did it happen?*

Exact date (optional)

Qualification*

Received medical treatment?Asked on every lead

Physically injured?“No” makes it DQ

Already has an attorney?“Yes” makes it DQ

Was it the lead’s fault?“Yes” makes it DQ

Case description (optional)

Step 3 of 4

Where did the lead come from?

Attribution and compliance data from the original submission.

source is the ad route only — e.g. 2.p, 1.fb. Never a test name or tag. This re-send is marked automatically in sub_id.

Attribution

source (ad route)*

domain (optional) Defaults to client.caraccidentcounsel.com/<source>

landingUrl (optional)

Click IDs & UTMsoptional

gclid

h_ad_id

fbc

fbp

GA4ClientId

ga4sessionid

utm_source

utm_medium

utm_campaign

utm_term

utm_content

referrerUrl

Compliance

TrustedForm certificate URL (optional) Full certificate URL — not just the ID

Jornaya LeadID (optional)

Lead IP (optional)

User agent (optional)

Step 4 of 4

Review and send

Check everything below — the lead goes to real buyers.

Authorize

Your name* Logged with this send

Team password*

Show full payload (JSON)