NFb v. Target: Class Member Intake Form

First Name :

Last Name :

Street Address :

City :

State :
Please Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip code :

Phone number (with area code) :

Email :

What is the degree of your vision impairment?

Please indicate what type of screen access software program you use to access websites.

Please provide a brief description of your experience(s) trying to use the Target.com website: