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Testimonial / Survey Form

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To submit your testimonial, please fill out the form below. For immediate assistance, please contact Maureen Jagos at 800-341-6038 or maureen.jagos@fop.net.

Contact Information

Participant Name:

Phone:

Email:

Attorney Information

Name:

Phone:

Incident Information

Plaintiff Name:

Case Type:

Date of Incident:

Date Reported:

Claim Status:

Date Closed:

Total Spent:

Below please provide a description of the incident and allegations:

Below please provide any additional comments relative to this case that would be worth mentioning. You can also use this section for any general comments about the FOP Legal Defense Plan.

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"It's better to have it and not need it, than to need it and not have it."