Discover Merchant Settlement Intake Form

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Mailing Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Did you or your business accept or process Discover credit cards in the United States between January 1, 2007 and December 31, 2023?

Are you a franchisor or franchisee?

Entity Structure

Legal name of business, entity or person that accepted and/or processed Discover credit cards 2007–2023

DBA / Trade Name(s) (if applicable)

(List all "doing business as" names used between 2007–2023)

Taxpayer Identification Number (TIN)

(SSN, EIN, or ITIN)

Business Address (if different from mailing address above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Business Phone (if different from above)

Please enter a valid phone number.Format: (000) 000-0000.

Business Email (if different from above)

example@example.com

Did you receive a notice about this settlement from the Settlement Administrator?

If YES — Claimant ID:

(10-character alphanumeric code from your notice)

If YES — PIN:

(6-digit number from your notice)

Are you or your business part of the above exclusion list?

Have you submitted a request to exclude yourself ("opt out") from the Discover Card Merchant Settlement?

Govt-Issued ID (Front)

Govt-Issued ID (Back)

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

(e.g., IRS letter, W-9, SS card, EIN confirmation)

Proof of Business Authority (One document showing you are the owner or authorized representative):

(e.g., IRS EIN Confirmation Letter, Articles of Incorporation/Organization, Business license or state registration, Operating Agreement, Merchant account agreement showing you as authorized signer)

Do you have signatory authority for the above-listed entity?

I confirm that the information provided in this intake form is accurate and complete to the best of my knowledge.

ATTORNEY ADVERTISING

By submitting this form, CLIENT ACKNOWLEDGES AND AGREES THAT:

Class members are not required to use a third-party filer.
Free help is available from Class Counsel and the Class Administrator. Additional information is available on the Court-approved Settlement website at www.DiscoverMerchantSettlement.com.
T.K. Sheth Law LLC DBA The Law Shed is an Illinois-licensed law firm, and all services provided under this Agreement are overseen by Tanvi K. Sheth, Principal Attorney.
Scope of Services & Jurisdiction: The Law Shed's role as a third-party filer is limited to preparing and submitting eligible claims under the Discover Card Merchant Class Action Settlement. We do not offer or provide legal services in jurisdictions where we are not admitted to practice, and nothing in this Agreement is intended to authorize the practice of law outside Illinois.
No Guarantee of Outcome: While The Law Shed will use reasonable efforts to pursue your claim, we do not guarantee any specific outcome or recovery amount.
Notwithstanding these acknowledgments, Client still desires to retain Attorney to assist with preparation, submission, and management of Client's Claim.

Client understands that Client has the right to consult with an independent attorney of Client's choice with respect to any and every aspect of this Attorney Representation Agreement.

Office Review

Discover Card Merchant Class Action Settlement Intake Form

SECTION 1: Your Contact Information

SECTION 2: ELIGIBILITY

SECTION 3: CLAIMANT INFORMATION

Provide Complete Details About Your Business/You

SECTION 4: NOTICE INFORMATION

SECTION 5: EXCLUSIONS

SECTION 6: OPT-OUT STATUS

SECTION 7: DOCUMENT UPLOADS

SECTION 8: AUTHORIZATION

Acknowledgment