TLS - Interchange Fee- Intake Form

Visa Mastercard Interchange Settlement Intake Form (Claim Deadline 2/4/2025)

Office Line: 312-219-2447 **Attorney Tanvi Kaushal Sheth Cell: 847.529.8279 (call for immediate response/txt+call if no response and try another channel)**Chief Operations Officer Monica James Cell: 312.384.8389(call for immediate response/txt+call if no response and try another channel)**Office Email: hi@thelawshed.com**Attorney Sheth Email: tks@thelawshed.com
Your Contact Information
Name*

First NameLast Name
Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Your Claim Information
Who Can File for a Claim:

“…all persons, businesses, and other entities that have accepted any Visa-Branded Cards and/or Mastercard-Branded Cards in the United States at any time from January 1, 2004 to the Settlement Preliminary Approval Date, i.e., the date of this Order…” (Citation: Order: Docket 7361, Page 3, Paragraph 1)
Between January 1, 2004 and January 24, 2019, did You accept any Visa or Mastercard-Branded Cards in United States *

YesNo
Identify Your Structure

Note: For each entity, submit a separate application. For example: suppose you had 3 candy stores during the relevant period, and your own qualifying solo activities, complete a separate engagement agreement for each candy store, and for your solo activities
Entity Structure*

Individual/Sole-proprietorshipPartnershipCorporationLimited Liability Company (LLC)TrustOther
Provide Complete Details About Your Business/You

(the entity for which you are completing this application)
Entity Details (write N/A where not applicable)*
Do You know the amount of Interchange Fees You paid during 1/12004 – 1/24/2019? (If you don’t, just leave it blank. Once your claim has been submitted, you will get an opportunity to view the records that the claim administrator has in their system)
Estimated Amount of Interchange Fees Paid, If known
Disqualification Criteria

(This is the list of Defendants and disqualified entities who cannot apply for this claim.If you choose Yes, STOP. You don’t qualify. If unsure, contact The Law Shed staff.)
EXCLUSION LIST:

1.     The United States government
2.     Any of these companies or their directors, officers, or family members:
a)     Visa U.S.A. Inc., Visa International Service Association, Visa Inc.
b)     Mastercard International Incorporated, Mastercard Incorporated
c)     Bank of America, N.A.; BA Merchant Services LLC; Bank of America Corporation; MBNA America Bank, N.A.; FIA Card Services, N.A.
d)     Barclays Bank plc; Barclays Delaware Holdings, LLC; Barclays Bank Delaware; Barclays Financial Corp.
e)     Capital One Bank (USA), N.A.; Capital One F.S.B.; Capital One Financial Corporation
f)      Chase Bank USA, N.A.; Paymentech, LLC; JPMorgan Chase & Co.; JPMorgan Chase Bank, N.A.
g)     Citibank (South Dakota), N.A.; Citibank, N.A.; Citigroup Inc.; Citicorp
h)     Fifth Third Bancorp
i)      First National Bank of Omaha
j)      HSBC Finance Corporation; HSBC Bank USA, N.A.; HSBC North America Holdings Inc.; HSBC Holdings plc; HSBC Bank plc; HSBC U.S.A. Inc.
k)     National City Corporation and National City Bank of Kentucky
l)      PNC Financial Services Group, Inc. and PNC Bank, National Association
m)   SunTrust Banks, Inc. and SunTrust Bank
n)     Texas Independent Bancshares, Inc.
o)     Wachovia Bank, N.A. and Wachovia Corporation
p)     Washington Mutual, Inc.; Washington Mutual Bank; Providian National Bank; Providian Financial Corporation
q)     Wells Fargo & Company and Wells Fargo Bank, N.A.
r)      A financial institution that has issued Visa or Mastercard branded cards or acquired Visa or Mastercard branded card transactions between January 1, 2004 and January 24, 2019
Are you part of the above-identified list? (In other words, are you the US Government OR director/officer/family member of the above identified list of companies):*

Yes (If Yes, Stop Here)NoNot Sure, contact office staff to discuss
Prior Claims
Have you previously filed a claim or received payment in any prior settlements in this case?*

YesNo
Opt-Out
Have You submitted a request to exclude Yourself, or "opt out of," Visa Mastercard Interchange Settlement.*

YesNoNot Sure, contact office staff
Disclaimers

- This form is provided by T.K. Sheth Law LLC dba The Law Shed dba The Law Shed, acting as a third-party claims filer for the Visa Mastercard Interchange Settlement.
- Class members are not required to use a third-party filer to participate in the settlement. Free help is available from Class Counsel and the Class Administrator. Additional information is available on the Court-approved Settlement website at https://www.paymentcardsettlement.com/en.
- Completion of this form does not guarantee eligibility for a settlement claim. Eligibility is determined by the Settlement Administrator.
- All information provided will be used solely for claim processing purposes and is subject to confidentiality obligations under applicable laws.
Upload Documents/Attachments
Take a Picture of Yourself Holding Your ID*
Govt-Issued ID (Front)*

Cancelof
Govt-Issued ID (Back)*

Cancelof
Taxpayer Identification Number (Document showing your name and SSN/TIN/EIN)*

Cancelof
Proof of Business Authority (if applicable): For entity claims, 1 document showing the individual as the owner or authorized representative.

Example: IRS EIN Confirmation Letter; Business license or state registration certificate showing the individual as an authorized representative; Articles of Incorporation or Organization (listing the individual as an owner or officer); Operating Agreement or Shareholder Agreement (identifying the individual’s role)Merchant account agreements (e.g., PayPal, Square, Stripe) naming the individual as the authorized signer; Annual Report etc.
Cancelof
Consent & Authorization
Do you have signatory authority for above listed entity?*

YesNo
Acknowledgment

I confirm that the information provided in this intake form is accurate and complete to the best of my knowledge.
Office Review
Should be Empty:

Visa Mastercard Interchange Settlement Intake Form (Claim Deadline 2/4/2025)

Your Contact Information

Your Claim Information

Who Can File for a Claim:

Identify Your Structure

Provide Complete Details About Your Business/You

Disqualification Criteria

Prior Claims

Opt-Out

Upload Documents/Attachments

Consent & Authorization

Acknowledgment