Visa/Mastercard Class Action Settlement Form

Submit Your Settlement Claim

By proceeding, you certify that you have the right to submit claims and make decisions regarding the recovery of funds for this business as an authorized representative of the business in question. This includes individuals such as business owners, executive officers, financial controllers, or others holding legal authority to act on behalf of the company.
Legal Business Name*
Your Taxpayer Identification Number (TIN)*
This is your company's Federal Tax ID Number.
Estimated Annual Credit Card Sales*
Please provide an estimate of how much your business charges customers on credit cards per year.
What Year Was The Business Formed? *
If available, also include years during which you accepted card payments between 2004-2019.
Your Name*
Current Title held at the Company*
Email*
Phone Number*
SMS and Privacy Policy*

By providing & telephone number and submitting the form you are consenting to be contacted by SMS text message. Message & data rates may apply. Reply STOP to opt out of further messaging. I agree.
Business Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
How did you hear about us?
If someone referred you, please provide their name here.
Please read the Engagement Letter and Terms below. You must scroll to the bottom of the document before checking the "I agree" box.
By signing below, Client Contact hereby represents that:

Client Contact has signatory authority for the Client Entity(ies); Such signatory authority permits Client Contact to direct Firefly Wealth Group, LLC and Sagemont Cost Recovery, LLC to file a claim on Client Entity(ies)’s behalf for the class action lawsuit known as In re Payment Card Interchange Fee and Merchant Discount Antitrust Litigation, MDL 1720 (MKB) (JO); and Client Contact hereby directs Sagemont Cost Recovery, LLC to file a claim on Client Entity(ies)’s behalf for the class action lawsuit known as In re Payment Card Interchange Fee and Merchant Discount Antitrust Litigation, MDL 1720 (MKB) (JO).
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Submit Your Settlement Claim

By signing below, Client Contact hereby represents that: