Phase 1 – Holy Comforter House, Inc – Progressive Online Intake If you or a loved one is interested in a case evaluation and complimentary mold testing by an expert, please complete this form. Full name Email Phone Were you a resident at Holy Comforter House, Inc. between August 1, 2019 to today? ---YesNo What apartment do you live or did you live in? When did you move in? How much do you pay per month? Have you seen black mold? ---YesNo Did you report seeing the mold? ---YesNo Have you been treated for respiratory or breathing issues? ---YesNo I agree to be a part of a Landlord-Tenant Act case which may become a class action according to the terms of the industry standard agreement of Gfile.Legal which I will later be requested to sign. I understand and agree that an injury or wrongful death case may be legally pursued. If no money is collected on your behalf, no fee is due. I understand the case would be filed against Holy Comforter House, Inc. with other Plaintiffs who also have similar claims. I also understand and agree Associate Attorneys may handle the matter and am agreeing to a legal investigation of my case for these purposes.