PROOF OF CLAIM FORM - ZORY GROUP, INC.

First Name*

Last Name*

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Cell Phone*

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SMS*

Yes
No

I agree for Cortiva Institute text messaging system (including SMS and MMS) to contact me even if my number is currently listed on any state, federal or corporate "Do Not Call list

Consent*

Yes
No

I consent to Cortiva Institute to contact me using either by autodialer, pre-recorded message, via telephone or mobile device and email, even if my number number is currently listed on any state, federal or corporate "Do Not Call list.

Name

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