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Submitted URL: http://link.abdataclassactionmail.com/ls/click?upn=UNmd-2FRNzC6uM5JdaxRoXtXikQgmY9IEY3Q-2FBKGB8M50sBKaJY-2B4kaoqcHcj5wrHcy6xV_VbMme-2F...
Effective URL: https://www.atmclassaction.com/claims
Submission Tags: falconsandbox
Submission: On April 26 via api from US — Scanned from DE
Effective URL: https://www.atmclassaction.com/claims
Submission Tags: falconsandbox
Submission: On April 26 via api from US — Scanned from DE
Form analysis 5 forms found in the DOM
<form _ngcontent-ng-cli-universal-c3="" autocomplete="off" novalidate="" class="ng-untouched ng-pristine ng-valid"><br _ngcontent-ng-cli-universal-c3=""><br _ngcontent-ng-cli-universal-c3="">
<ul _ngcontent-ng-cli-universal-c3="" class="list-inline float-right">
<li _ngcontent-ng-cli-universal-c3=""><button _ngcontent-ng-cli-universal-c3="" cdksteppernext="" class="btn btn-primary" type="submit">Next</button></li>
</ul>
</form><form _ngcontent-ng-cli-universal-c3="" autocomplete="off" novalidate="" class="ng-untouched ng-pristine ng-valid"><br _ngcontent-ng-cli-universal-c3=""><br _ngcontent-ng-cli-universal-c3="">
<ul _ngcontent-ng-cli-universal-c3="" class="list-inline float-right">
<li _ngcontent-ng-cli-universal-c3=""><button _ngcontent-ng-cli-universal-c3="" cdksteppernext="" class="btn btn-primary" type="submit">Next</button></li>
</ul>
</form><form _ngcontent-ng-cli-universal-c4="" autocomplete="off" novalidate="" class="ng-untouched ng-pristine ng-invalid">
<div _ngcontent-ng-cli-universal-c4="" class="row rowformat">
<div _ngcontent-ng-cli-universal-c4="" class="col-md-6">
<div _ngcontent-ng-cli-universal-c4="" class="form-group"><label _ngcontent-ng-cli-universal-c4="" for="uniqueId"><b _ngcontent-ng-cli-universal-c4="">Notice ID Number (If Email Notice Sent To You):</b></label><input
_ngcontent-ng-cli-universal-c4="" autocomplete="no" class="form-control ng-untouched ng-pristine ng-valid" formcontrolname="uniqueId" mask="00000-00000" trim="blur" type="text"><!----></div>
</div>
</div>
<div _ngcontent-ng-cli-universal-c4="" class="row rowformat">
<div _ngcontent-ng-cli-universal-c4="" class="col-md-12">
<div _ngcontent-ng-cli-universal-c4="" class="form-group"><label _ngcontent-ng-cli-universal-c4="" for="name1"><b _ngcontent-ng-cli-universal-c4="">Name:</b><span _ngcontent-ng-cli-universal-c4="" class="required" style="color:red">
*</span></label><input _ngcontent-ng-cli-universal-c4="" autocomplete="no" class="form-control ng-untouched ng-pristine ng-invalid" formcontrolname="name1" placeholder="Full Name" trim="blur" type="text"><!----></div>
</div>
</div>
<div _ngcontent-ng-cli-universal-c4="" class="row rowformat">
<div _ngcontent-ng-cli-universal-c4="" class="col-md-12">
<div _ngcontent-ng-cli-universal-c4="" class="form-group"><label _ngcontent-ng-cli-universal-c4="" for="street1"><b _ngcontent-ng-cli-universal-c4="">Street Address:</b><span _ngcontent-ng-cli-universal-c4="" class="required" style="color:red">
*</span></label><input _ngcontent-ng-cli-universal-c4="" autocomplete="no" class="form-control ng-untouched ng-pristine ng-invalid" formcontrolname="street1" trim="blur" type="text"><!----></div>
</div>
</div>
<div _ngcontent-ng-cli-universal-c4="" class="row rowformat">
<div _ngcontent-ng-cli-universal-c4="" class="col-md-6">
<div _ngcontent-ng-cli-universal-c4="" class="form-group"><label _ngcontent-ng-cli-universal-c4="" for="country"><b _ngcontent-ng-cli-universal-c4="">Country:</b><span _ngcontent-ng-cli-universal-c4="" class="required" style="color:red">
*</span></label><select _ngcontent-ng-cli-universal-c4="" class="form-control ng-untouched ng-pristine ng-invalid" formcontrolname="country">
<option _ngcontent-ng-cli-universal-c4="" value="">Please Select A Country</option><!---->
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> United States </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Afghanistan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Albania </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Algeria </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Andorra </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Angola </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Antigua and Barbuda </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Argentina </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Armenia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Australia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Austria </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Azerbaijan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Bahamas </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Bahrain </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Bangladesh </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Barbados </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Belarus </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Belgium </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Belize </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Benin </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Africa </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Bhutan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Bolivia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Bosnia and Herzegovina </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Botswana </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Brazil </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Brunei Darussalam </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Bulgaria </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Burkina Faso </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Burundi </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Cambodia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Cameroon </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Canada </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Cape Verde </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Cayman Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Central African Republic </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Chad </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Chile </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> China </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Colombia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Comoros </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Congo </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Congo, The Democratic Republic of the </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Costa Rica </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Côte d'Ivoire, Republic of </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Croatia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Cuba </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Curaçao </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Cyprus </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Czech Republic </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Denmark </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Djibouti </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Dominica </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Dominican Republic </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Ecuador </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Egypt </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> El Salvador </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Equatorial Guinea </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Eritrea </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Estonia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Ethiopia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Falkland Islands (Malvinas) </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Faroe Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Fiji </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Finland </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> France </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> French Guiana </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> French Polynesia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> French Southern Territories </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Gabon </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Gambia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Georgia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Germany </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Ghana </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Gibraltar </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Greece </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Greenland </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Grenada </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Guadeloupe </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Guam </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Guatemala </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Guernsey </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Guinea </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Guinea-Bissau </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Guyana </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Haiti </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Heard Island and Mcdonald Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Holy See (Vatican City State) </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Honduras </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Hong Kong </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Hungary </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Iceland </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> India </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Indonesia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Iran, Islamic Republic Of </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Iraq </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Ireland </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Isle of Man </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Israel </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Italy </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Jamaica </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Japan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Jersey </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Jordan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Kazakhstan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Kenya </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Kiribati </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Korea, Democratic People's Republic of </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Korea, Republic of </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Kuwait </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Kyrgyzstan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Lao People's Democratic Republic </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Latvia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Lebanon </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Lesotho </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Liberia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Libyan Arab Jamahiriya </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Liechtenstein </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Lithuania </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Luxembourg </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Macedonia, The Former Yugoslav Republic of </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Madagascar </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Malawi </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Malaysia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Maldives </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Mali </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Malta </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Marshall Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Martinique </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Mauritania </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Mauritius </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Mayotte </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Mexico </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Micronesia, Federated States of </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Moldova, Republic of </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Monaco </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Mongolia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Montenegro </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Montserrat </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Morocco </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Mozambique </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Myanmar </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Namibia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Nauru </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Nepal </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Netherlands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Netherlands Antilles </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> New Caledonia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> New Zealand </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Nicaragua </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Niger </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Nigeria </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Niue </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Norfolk Island </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Northern Mariana Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Norway </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Oman </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Pakistan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Palau </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Palestinian Territory, Occupied </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Panama </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Papua New Guinea </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Paraguay </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Peru </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Philippines </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Pitcairn </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Poland </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Portugal </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Puerto Rico </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Qatar </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Réunion </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Romania </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Russian Federation </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Rwanda </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Saint Helena, Ascension and Tristan da Cunha </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Saint Kitts and Nevis </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Saint Lucia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Saint Pierre and Miquelon </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Saint Vincent and the Grenadines </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Samoa </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> San Marino </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> São Tomé and Príncipe </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Saudi Arabia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Senegal </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Serbia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Seychelles </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Sierra Leone </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Singapore </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Sint Maarten </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Slovakia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Slovenia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Solomon Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Somalia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> South Africa </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> South Georgia and the South Sandwich Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> South Sudan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Spain </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Sri Lanka </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Sudan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Surinone </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Svalbard and Jan Mayen </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Swaziland </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Sweden </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Switzerland </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Syrian Arab Republic </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Taiwan, Province of China </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> tajikistan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Tanzania, United Republic of </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Thailand </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Timor-Leste </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Togo </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Tokelau </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Tonga </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Trinidad and Tobago </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Tunisia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Turkey </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Turkmenistan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Turks and Caicos Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Tuvalu </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Uganda </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Ukraine </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> United Arab Emirates </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> United Kingdom </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> United States Minor Outlying Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Uruguay </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Uzbekistan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Vanuatu </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Venezuela </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Viet Nam </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Virgin Islands, British </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Virgin Islands, U.S. </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Wallis and Futuna </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Western Sahara </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Yemen </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Zambia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Zimbabwe </option>
</select><!----></div>
</div>
<div _ngcontent-ng-cli-universal-c4="" class="col-md-6">
<div _ngcontent-ng-cli-universal-c4="" class="form-group"><label _ngcontent-ng-cli-universal-c4="" for="city"><b _ngcontent-ng-cli-universal-c4="">City:</b><span _ngcontent-ng-cli-universal-c4="" class="required" style="color:red">
*</span></label><input _ngcontent-ng-cli-universal-c4="" autocomplete="no" class="form-control ng-untouched ng-pristine ng-invalid" formcontrolname="city" trim="blur" type="text"><!----></div>
</div>
</div>
<div _ngcontent-ng-cli-universal-c4="" class="row rowformat"><!----></div><!---->
<div _ngcontent-ng-cli-universal-c4="" class="row rowformat ng-star-inserted">
<div _ngcontent-ng-cli-universal-c4="" class="col-md-6">
<div _ngcontent-ng-cli-universal-c4="" class="form-group"><label _ngcontent-ng-cli-universal-c4="" for="state"><b _ngcontent-ng-cli-universal-c4="">State:</b><span _ngcontent-ng-cli-universal-c4="" class="required" style="color:red">
*</span></label><select _ngcontent-ng-cli-universal-c4="" class="form-control ng-untouched ng-pristine ng-invalid" formcontrolname="state">
<option _ngcontent-ng-cli-universal-c4="" value="">Please Select A State</option><!---->
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Alabama </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Alaska </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Arizona </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Arkansas </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> California </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Colorado </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Connecticut </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Delaware </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Florida </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Georgia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Hawaii </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Idaho </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Illinois </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Indiana </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Iowa </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Kansas </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Kentucky </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Louisiana </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Maine </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Maryland </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Massachusetts </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Michigan </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Minnesota </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Mississippi </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Missouri </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Montana </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Nebraska </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Nevada </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> New Hampshire </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> New Jersey </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> New Mexico </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> New York </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> North Carolina </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> North Dakota </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Ohio </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Oklahoma </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Oregon </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Pennsylvania </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Rhode Island </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> South Carolina </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> South Dakota </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Tennessee </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Texas </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Utah </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Vermont </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Virginia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Washington </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> West Virginia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Wisconsin </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Wyoming </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> District Of Columbia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> American Samoa </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Federated States of Micronesia </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Guam </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Marshall Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Northern Mariana Islands </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Puerto Rico </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Palau </option>
<option _ngcontent-ng-cli-universal-c4="" class="ng-star-inserted"> Virgin Islands </option>
</select><!----></div>
</div>
<div _ngcontent-ng-cli-universal-c4="" class="col-md-6">
<div _ngcontent-ng-cli-universal-c4="" class="form-group"><label _ngcontent-ng-cli-universal-c4="" for="zip"><b _ngcontent-ng-cli-universal-c4="">Zip Code:</b><span _ngcontent-ng-cli-universal-c4="" class="required" style="color:red">
*</span></label><input _ngcontent-ng-cli-universal-c4="" autocomplete="no" class="form-control ng-untouched ng-pristine ng-invalid" formcontrolname="zip" trim="blur" type="text"><!----></div>
</div>
</div>
<div _ngcontent-ng-cli-universal-c4="" class="row rowformat">
<div _ngcontent-ng-cli-universal-c4="" class="col-md-6">
<div _ngcontent-ng-cli-universal-c4="" class="form-group"><label _ngcontent-ng-cli-universal-c4="" for="mobilePhone"><b _ngcontent-ng-cli-universal-c4="">Mobile Phone:</b><span _ngcontent-ng-cli-universal-c4="" class="required"
style="color:red"> *</span></label><input _ngcontent-ng-cli-universal-c4="" autocomplete="no" class="form-control ng-untouched ng-pristine ng-valid" formcontrolname="mobilePhone" trim="blur" type="text"><!----></div>
</div>
</div>
<div _ngcontent-ng-cli-universal-c4="" class="row rowformat">
<div _ngcontent-ng-cli-universal-c4="" class="col-md-6">
<div _ngcontent-ng-cli-universal-c4="" class="form-group"><label _ngcontent-ng-cli-universal-c4="" for="email"><b _ngcontent-ng-cli-universal-c4="">Email Address:</b><span _ngcontent-ng-cli-universal-c4="" class="required" style="color:red">
*</span></label><input _ngcontent-ng-cli-universal-c4="" autocomplete="no" class="form-control ng-untouched ng-pristine ng-invalid" formcontrolname="email" trim="blur" type="text"><!----></div>
</div>
<div _ngcontent-ng-cli-universal-c4="" class="col-md-6">
<div _ngcontent-ng-cli-universal-c4="" class="form-group"><label _ngcontent-ng-cli-universal-c4="" for="confirmEmail"><b _ngcontent-ng-cli-universal-c4="">Verify Email Address:</b><span _ngcontent-ng-cli-universal-c4="" class="required"
style="color:red"> *</span></label><input _ngcontent-ng-cli-universal-c4="" autocomplete="no" class="form-control ng-untouched ng-pristine ng-invalid" formcontrolname="confirmEmail" trim="blur" type="text"><!----></div>
</div>
</div><br _ngcontent-ng-cli-universal-c4="">
<div _ngcontent-ng-cli-universal-c4="" class="row rowformat">
<div _ngcontent-ng-cli-universal-c4="" class="col-md-12" style="font-size: 1.0em; text-align: justify; text-justify: distribute-all-lines"> Please ensure you provide a current, valid email address and mobile phone number with your claim
submission. If the email address or mobile phone number you include with your submission becomes invalid for any reason, it is your responsibility to provide the Claims Administrator with a current, valid email address and mobile phone number
for payment. </div>
</div><br _ngcontent-ng-cli-universal-c4=""><br _ngcontent-ng-cli-universal-c4=""><br _ngcontent-ng-cli-universal-c4="">
<ul _ngcontent-ng-cli-universal-c4="" class="list-inline float-right">
<li _ngcontent-ng-cli-universal-c4=""><button _ngcontent-ng-cli-universal-c4="" cdkstepperprevious="" class="btn btn-primary" type="button">Back</button> <button _ngcontent-ng-cli-universal-c4="" cdksteppernext="" class="btn btn-primary"
type="submit">Next</button></li>
</ul>
</form><form _ngcontent-ng-cli-universal-c5="" autocomplete="off" novalidate="" class="ng-untouched ng-pristine ng-valid">
<div _ngcontent-ng-cli-universal-c5="" class="row">
<div _ngcontent-ng-cli-universal-c5="" class="col-md-12"><label _ngcontent-ng-cli-universal-c5="" for="purchsedForPersonalUse"> HAVE YOU PAID AN UNREIMBURSED SURCHARGE TO WITHDRAW CASH FROM AN ATM IN THE UNITED STATES AT ANY POINT ON OR AFTER
OCTOBER 1, 2007? </label></div>
</div>
<div _ngcontent-ng-cli-universal-c5="" class="row">
<div _ngcontent-ng-cli-universal-c5="" class="col-md-12"><label _ngcontent-ng-cli-universal-c5="" class="radio-inline "><input _ngcontent-ng-cli-universal-c5="" formcontrolname="paidUnreimbursedSurcharge" name="paidUnreimbursedSurcharge"
type="radio" value="Yes" class="ng-untouched ng-pristine ng-valid"><span _ngcontent-ng-cli-universal-c5="" style="font-weight:bold"> Yes</span></label> <label _ngcontent-ng-cli-universal-c5="" class="radio-inline"><input
_ngcontent-ng-cli-universal-c5="" formcontrolname="paidUnreimbursedSurcharge" name="paidUnreimbursedSurcharge" type="radio" value="No" class="ng-untouched ng-pristine ng-valid"><span _ngcontent-ng-cli-universal-c5=""
style="font-weight:bold"> No</span></label><br _ngcontent-ng-cli-universal-c5=""><!----></div>
</div><!----><!----><!----><br _ngcontent-ng-cli-universal-c5=""><br _ngcontent-ng-cli-universal-c5="">
<ul _ngcontent-ng-cli-universal-c5="" class="list-inline float-right">
<li _ngcontent-ng-cli-universal-c5=""><button _ngcontent-ng-cli-universal-c5="" cdkstepperprevious="" class="btn btn-primary" type="button">Back</button> <button _ngcontent-ng-cli-universal-c5="" cdksteppernext="" class="btn btn-primary"
type="submit">Next</button></li>
</ul>
</form><form _ngcontent-ng-cli-universal-c6="" autocomplete="off" novalidate="" class="ng-untouched ng-pristine ng-invalid">
<div _ngcontent-ng-cli-universal-c6="" class="row rowformat">
<div _ngcontent-ng-cli-universal-c6="" class="col-md-12">
<div _ngcontent-ng-cli-universal-c6="" class="form-group"><label _ngcontent-ng-cli-universal-c6="" for="signature"><b _ngcontent-ng-cli-universal-c6="">Your signature (type name):</b><span _ngcontent-ng-cli-universal-c6="" class="required"
style="color:red"> *</span></label><input _ngcontent-ng-cli-universal-c6="" autocomplete="no" class="form-control ng-untouched ng-pristine ng-invalid" formcontrolname="signature" id="signature" trim="blur" type="text"><!----></div>
</div>
</div><br _ngcontent-ng-cli-universal-c6=""><br _ngcontent-ng-cli-universal-c6=""><br _ngcontent-ng-cli-universal-c6="">
<ul _ngcontent-ng-cli-universal-c6="" class="list-inline float-right">
<li _ngcontent-ng-cli-universal-c6=""><button _ngcontent-ng-cli-universal-c6="" cdkstepperprevious="" class="btn btn-primary" type="button">Back</button> <button _ngcontent-ng-cli-universal-c6="" cdksteppernext="" class="btn btn-primary"
type="submit">Submit</button></li>
</ul>
</form>Text Content
* Home
* File A Claim
* Notice
* Court Documents
* Contact Information
1. 1
2. 2
3. 3
4. 4
ANDREW MACKMIN, ET AL. V. VISA INC., ET AL., NO. 1:11-CV-01831
CLAIM FORM INSTRUCTIONS
This class action alleges Defendants violated federal antitrust laws by adopting
restraints that allegedly inflated the ATM surcharges paid by the Class.
Defendants deny these allegations.
You are a Settlement Class Member if, between October 1, 2007 and November 12,
2021, you paid a surcharge to withdraw cash from a bank ATM in the United
States. You are excluded from the Settlement Class if all of your surcharged ATM
transactions were (a) reimbursed, or (b) conducted on cards issued by financial
institutions located outside of the United States.
To be eligible for payment you must submit a valid claim no later than May 11,
2022.
Settlement payments will be digitally sent to you via email. Please ensure you
provide a current, valid email address and mobile phone number with your claim
submission. If the email address or mobile phone number you include with your
submission becomes invalid for any reason, it is your responsibility to provide
accurate contact information to the Claims Administrator to receive a payment.
When you receive the email and/or mobile phone text notifying you of your
Settlement payment, you will be provided with a number of digital payment
options such as PayPal or a virtual debit card, to immediately receive your
Settlement payment. You will also at that time have the option to request a
paper check.
The information provided on this Claim Form will be used solely by the
Court-approved Claims Administrator for the purposes of administering the
Settlements and will not be provided to any third party or sold for marketing
purposes.
* Next
Andrew Mackmin, et al. v. Visa Inc., et al., No. 1:11-cv-01831
CLAIM FORM INSTRUCTIONS
This class action alleges Defendants violated federal antitrust laws by adopting
restraints that allegedly inflated the ATM surcharges paid by the Class.
Defendants deny these allegations.
You are a Settlement Class Member if, between October 1, 2007 and November 12,
2021, you paid a surcharge to withdraw cash from a bank ATM in the United
States. You are excluded from the Settlement Class if all of your surcharged ATM
transactions were (a) reimbursed, or (b) conducted on cards issued by financial
institutions located outside of the United States.
To be eligible for payment you must submit a valid claim no later than May 11,
2022.
Settlement payments will be digitally sent to you via email. Please ensure you
provide a current, valid email address and mobile phone number with your claim
submission. If the email address or mobile phone number you include with your
submission becomes invalid for any reason, it is your responsibility to provide
accurate contact information to the Claims Administrator to receive a payment.
When you receive the email and/or mobile phone text notifying you of your
Settlement payment, you will be provided with a number of digital payment
options such as PayPal or a virtual debit card, to immediately receive your
Settlement payment. You will also at that time have the option to request a
paper check.
The information provided on this Claim Form will be used solely by the
Court-approved Claims Administrator for the purposes of administering the
Settlements and will not be provided to any third party or sold for marketing
purposes.
* Next
CLAIMANT INFORMATION
Notice ID Number (If Email Notice Sent To You):
Name: *
Street Address: *
Country: *Please Select A Country United States Afghanistan Albania Algeria
Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria
Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin
Africa Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam
Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands
Central African Republic Chad Chile China Colombia Comoros Congo Congo, The
Democratic Republic of the Costa Rica Côte d'Ivoire, Republic of Croatia Cuba
Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic
Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland
Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French
Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana
Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea
Guinea-Bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican
City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic
Republic Of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan
Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic
of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho
Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macedonia, The
Former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta
Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia,
Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat
Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles
New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern
Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied
Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal
Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Helena,
Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Pierre
and Miquelon Saint Vincent and the Grenadines Samoa San Marino São Tomé and
Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint
Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and
the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Surinone Svalbard
and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province
of China tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo
Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos
Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States
Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin
Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen
Zambia Zimbabwe
City: *
State: *Please Select A State Alabama Alaska Arizona Arkansas California
Colorado Connecticut Delaware 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 District Of Columbia American Samoa
Federated States of Micronesia Guam Marshall Islands Northern Mariana Islands
Puerto Rico Palau Virgin Islands
Zip Code: *
Mobile Phone: *
Email Address: *
Verify Email Address: *
Please ensure you provide a current, valid email address and mobile phone number
with your claim submission. If the email address or mobile phone number you
include with your submission becomes invalid for any reason, it is your
responsibility to provide the Claims Administrator with a current, valid email
address and mobile phone number for payment.
* Back Next
ATM SURCHARGE INFORMATION
HAVE YOU PAID AN UNREIMBURSED SURCHARGE TO WITHDRAW CASH FROM AN ATM IN THE
UNITED STATES AT ANY POINT ON OR AFTER OCTOBER 1, 2007?
Yes No
* Back Next
CERTIFICATION
"AS STATED BELOW, THIS CLAIM FORM IS SUBMITTED UNDER PENALTY OF PERJURY, AND THE
CLAIMS ADMINISTRATOR RESERVES THE RIGHT TO REQUEST BANK STATEMENTS OR OTHER
DOCUMENTATION SUPPORTING YOUR CLAIM."
By signing this claim submission, I certify, under penalty of perjury, that the
information included with this claim submission is accurate and complete to the
best of my knowledge, information, and belief. If I am submitting this claim
submission on behalf of a claimant, I certify that I am authorized to submit
this claim submission on the individual’s behalf. I am, or the individual on
whose behalf I am submitting this claim submission is, a member of the
Settlement Class, and have not submitted a request to exclude myself, or “opt
out of,” the Settlements. I agree and consent to be communicated with
electronically via email and/or mobile phone text (message & data rates may
apply). I agree to furnish additional information regarding this claim
submission if so requested to do by the Settlement Administrator.
Your signature (type name): *
* Back Submit
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