Assisting Business Owners with Submitting Their Claim for the Payment Card Interchange Fee Class Action Lawsuit (Jan 1,2004-Jan 25,2019)Please complete all fields*
Referred By:
*
First Name
Last Name
Referred By Email:
*
example@example.com
Company Name
*
Authorized Signer / Business Owner
*
First Name
Last Name
Title
*
Email
*
example@example.com
Phone Number
*
Mailing address (Where to send the check to)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you have multiple companies?
Yes
No
If you have multiple companies, how many?
Submit
Should be Empty: