mexicocarrentalsettlement.com Open in urlscan Pro
18.211.4.112 Public Scan

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Submitted URL:
https://lzzgcc5d.r.us-east-1.awstrack.me/L0/https:%2F%2Fmexicocarrentalsettlement.com%2Fsubmit-claim.php/1/0100017d05f26043-e39a841f-d675...
Effective URL:
https://mexicocarrentalsettlement.com/submit-claim.php
Submission: On November 09 via manual (November 9th 2021, 9:28:59 pm UTC) from IN — Scanned from US

Form analysis
2 forms found in the DOM

POST

<form id="guard" method="post" class="">
  <fieldset id="notice-confirmation" class="width40 float-left">
    <p>If you received a personalized notice in the mail or via email with a <strong class="underline">Notice ID</strong> and <strong class="underline">Confirmation Code</strong>, please enter the codes you were provided below.</p>
    <p>Please remember to enter the full Notice ID exactly as it appears on your personalized Notice, (i.e. 12345678).</p>
    <div>
      <input type="text" id="zero_zero_id" name="zero_zero_id" data-validate="required">
      <label for="zero_zero_id">Notice ID <span class="error"></span></label>
    </div>
    <div>
      <input type="text" id="confirmation_code" name="confirmation_code" data-validate="required">
      <label for="confirmation_code">Confirmation Code <span class="error"></span></label>
    </div>
    <div>
      <input type="submit" id="submit-guard" value="Submit">
    </div>
  </fieldset>
  <p class="center underline width20 float-left"><strong>OR</strong></p>
  <fieldset class="width40 float-left">
    <p>If you did not receive a personalized Notice in the mail or via email, click below to complete a Claim Form.</p>
    <input type="button" id="skip-guard" value="Click Here">
  </fieldset>
  <p class="clearfix" style="font-size: 12px;">Please note that this claims portal is scheduled to close on <span id="deadline_datetime">November 23, 2021 at 11:59:59 P.M.</span> Pacific Time.</p>
</form>

POST

<form id="form" method="post" class="hide">
  <h3 class="center"><strong>Hertz DTAG Mexico Car Rental Class Action Settlement Online Claim Form</strong></h3>
  <p>To make a claim under the Hertz DTAG Mexico Car Rental Class Action Settlement (the “Settlement”), you must complete this form. Your claim form must be submitted by November 23, 2021. The information in your claim will be used only for purposes
    of administering this Settlement (such as to audit and review a claim for completeness, truth, and accuracy). The amount you will receive depends on the number of rental days and the number of other claims filed in the Settlement.</p>
  <p>Payments will be issued only if the Court approves the Settlement and the Effective Date of the Settlement occurs.</p>
  <fieldset id="contact-info">
    <div class="width50">
      <input type="text" name="first_name" id="first_name" data-validate="required">
      <label for="first_name">First Name *<span class="error"></span></label>
    </div>
    <div class="width50">
      <input type="text" name="last_name" id="last_name" data-validate="required">
      <label for="last_name">Last Name *<span class="error"></span></label>
    </div>
    <div class="width100">
      <input type="email" name="email_address" id="email_address" data-validate="required email">
      <label for="email_address">Email Address *<span class="error"></span></label>
    </div>
    <div class="width100">
      <input type="text" name="street_address_1" id="street_address_1" data-validate="required">
      <label for="street_address_1">Mailing Address *<span class="error"></span></label>
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    <div class="width50">
      <input type="text" name="city" id="city" data-validate="required">
      <label for="city">City *<span class="error"></span></label>
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    <div class="width25">
      <select name="state" id="state" data-validate="required">
        <option value="" selected="selected"></option>
        <option value="AL">Alabama</option>
        <option value="AK">Alaska</option>
        <option value="AZ">Arizona</option>
        <option value="AR">Arkansas</option>
        <option value="CA">California</option>
        <option value="CO">Colorado</option>
        <option value="CT">Connecticut</option>
        <option value="DE">Delaware</option>
        <option value="DC">District Of Columbia</option>
        <option value="FL">Florida</option>
        <option value="GA">Georgia</option>
        <option value="HI">Hawaii</option>
        <option value="ID">Idaho</option>
        <option value="IL">Illinois</option>
        <option value="IN">Indiana</option>
        <option value="IA">Iowa</option>
        <option value="KS">Kansas</option>
        <option value="KY">Kentucky</option>
        <option value="LA">Louisiana</option>
        <option value="ME">Maine</option>
        <option value="MD">Maryland</option>
        <option value="MA">Massachusetts</option>
        <option value="MI">Michigan</option>
        <option value="MN">Minnesota</option>
        <option value="MS">Mississippi</option>
        <option value="MO">Missouri</option>
        <option value="MT">Montana</option>
        <option value="NE">Nebraska</option>
        <option value="NV">Nevada</option>
        <option value="NH">New Hampshire</option>
        <option value="NJ">New Jersey</option>
        <option value="NM">New Mexico</option>
        <option value="NY">New York</option>
        <option value="NC">North Carolina</option>
        <option value="ND">North Dakota</option>
        <option value="OH">Ohio</option>
        <option value="OK">Oklahoma</option>
        <option value="OR">Oregon</option>
        <option value="PA">Pennsylvania</option>
        <option value="RI">Rhode Island</option>
        <option value="SC">South Carolina</option>
        <option value="SD">South Dakota</option>
        <option value="TN">Tennessee</option>
        <option value="TX">Texas</option>
        <option value="UT">Utah</option>
        <option value="VT">Vermont</option>
        <option value="VA">Virginia</option>
        <option value="WA">Washington</option>
        <option value="WV">West Virginia</option>
        <option value="WI">Wisconsin</option>
        <option value="WY">Wyoming</option>
        <option value="AE">Armed Forces - Africa, Canada, Europe, Middle East</option>
        <option value="AA">Armed Forces - Americas</option>
        <option value="AP">Armed Forces - Pacific</option>
        <option value="AS">American Samoa</option>
        <option value="GU">Guam</option>
        <option value="MH">Marshall Islands</option>
        <option value="MP">Northern Mariana Islands</option>
        <option value="PR">Puerto Rico</option>
        <option value="VI">US Virgin Islands</option>
      </select>
      <label for="state">State *<span class="error"></span></label>
    </div>
    <div class="width25">
      <input type="text" name="zip_code" id="zip_code" data-validate="required zip-code">
      <label for="zip_code">Zip Code *<span class="error"></span></label>
    </div>
    <div class="width100">* Required Fields</div>
  </fieldset>
  <fieldset id="rental-information">
    <legend><strong>Rental Information</strong></legend>
    <table>
      <thead>
        <tr>
          <th>Rental Brand</th>
          <th>Approximate Rental Date</th>
          <th>Number of Rental Days</th>
          <th>Reservation Number</th>
        </tr>
      </thead>
      <tbody>
        <tr>
          <td>
            <select name="vehicle_brand_1" id="vehicle_brand_1" data-validate="" data-label="Rental Brand 1">
              <option value="" selected="selected"></option>
              <option value="Hertz">Hertz</option>
              <option value="Dollar/Thrifty">Dollar/Thrifty</option>
            </select>
            <label for="vehicle_brand_1"><span class="error"></span></label>
          </td>
          <td>
            <input type="text" name="vehicle_date_1" id="vehicle_date_1" placeholder="MM/DD/YYYY" data-validate="date" data-date-format="MM/DD/YYYY" data-date-min="2009-01-02" data-date-max="2019-01-01" data-date-default="2009-01-02"
              data-label="Rental Date 1" autocomplete="off">
            <label for="vehicle_date_1"><span class="error"></span></label>
          </td>
          <td>
            <input type="number" name="vehicle_days_1" id="vehicle_days_1" min="0" data-validate="integer" data-label="Number of Rental Days 1">
            <label for="vehicle_days_1"><span class="error"></span></label>
          </td>
          <td>
            <input type="text" name="reservation_number_1" id="reservation_number_1" data-validate="" data-label="Reservation Number 1">
            <label for="reservation_number_1"><span class="error"></span></label>
          </td>
        </tr>
      </tbody>
    </table>
    <br>
    <span id="add_rental">+ Add another rental</span>
  </fieldset>
  <fieldset id="confirm-checks">
    <legend><strong>NOTICE: YOU MUST CONFIRM THE TRUTH OF ALL OF THE FOLLOWING, UNDER PENALTY OF PERJURY, PERJURY IS A CRIME. YOUR CLAIM IS SUBJECT TO VERIFICATION:</strong></legend>
    <div class="width100">
      <input type="checkbox" name="cert_check_1" id="cert_check_1" value="Yes" data-validate="required" data-label="I paid a daily rate for my rental that was higher than what was quoted to me when I booked online">
      <label for="cert_check_1">I paid a daily rate for my rental that was higher than what was quoted to me when I booked online. <span class="error"></span></label>
    </div>
    <div class="width100">
      <input type="checkbox" name="cert_check_2" id="cert_check_2" value="Yes" data-validate="required" data-label="I have not received a refund for the rentals described above">
      <label for="cert_check_2">I have not received a refund for the rentals described above. <span class="error"></span></label>
    </div>
  </fieldset>
  <fieldset id="payment-information">
    <legend><strong>PAYMENT INFORMATION</strong></legend>
    <p class="hide" id="update_payment_message">You have successfully requested a <span id="previous_payment_method"></span> payment. <span id="update_payment_toggle">Click here if you would like to choose a different payment method.</span></p>
    <div id="dst-payment" key="0b3d49eb70f17b4215bb8bc2cd8d112f6907b5e0f294fbc691dae73007e2c2b5"><iframe frameborder="0"
        src="https://content.digitaldisbursements.com/v1.4.3/index.html?0b3d49eb70f17b4215bb8bc2cd8d112f6907b5e0f294fbc691dae73007e2c2b5&amp;%7B%22verify%22%3Afalse%7D" style="border: none; width: 100%; height: 0px; overflow: hidden;"></iframe></div>
    <script src="https://content.digitaldisbursements.com/v1.4.3/assets/host.js"></script>
    <script type="text/javascript">
      dstPaymentForm(document.getElementById('dst-payment'), {
        verify: false,
        onSubmitted: function(info) {
          document.getElementById('payment_method').value = info.method;
          document.getElementById('payment_token').value = info.token;
        }
      })
    </script>
  </fieldset>
  <fieldset id="certification">
    <legend><strong>*I SWEAR OR AFFIRM THE TRUTH OF ALL THE INFORMATION ON THIS CLAIM FORM UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES, AFFIRM THE JURISDICTION OF THE BANKRUPTCY COURT OVER ALL MATTERS RELATED TO THE SETTLEMENT AND
        THIS CLAIM, AND CONSENT TO ITS AUTHORITY TO ENTER A FINAL ORDER APPROVING THE SETTLEMENT.</strong></legend>
    <div class="width100">
      <input style="margin-right: 0;" type="text" name="signature" id="signature" placeholder="Type Full name" class="width50" data-validate="required">
      <label for="signature">Signature *<span class="error"></span></label>
    </div>
    <div class="width25">
      <input type="text" id="date" name="date" disabled="disabled" value="11/09/2021">
      <label for="date">Date </label>
    </div>
  </fieldset>
  <input type="hidden" id="payment_method" value="" data-label="Payment Method">
  <input type="hidden" id="payment_token" value="" data-label="Payment Token">
  <input type="hidden" id="preloaded_rentals" value="" data-label="Preloaded Rentals">
  <input type="submit" id="submit-claim" value="Submit">
</form>

Text Content

IN RE THE HERTZ CORPORATION, ET AL.


CASE NO. 20-11218


UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF DELAWARE

 1. Submit a Claim

MENU
 * Home
 * Submit a Claim
 * Opt Out
 * Important Documents
 * FAQs
 * Contact Us

If you received a personalized notice in the mail or via email with a Notice ID
and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Notice ID exactly as it appears on your
personalized Notice, (i.e. 12345678).

Notice ID
Confirmation Code


OR

If you did not receive a personalized Notice in the mail or via email, click
below to complete a Claim Form.

Please note that this claims portal is scheduled to close on November 23, 2021
at 11:59:59 P.M. Pacific Time.


HERTZ DTAG MEXICO CAR RENTAL CLASS ACTION SETTLEMENT ONLINE CLAIM FORM

To make a claim under the Hertz DTAG Mexico Car Rental Class Action Settlement
(the “Settlement”), you must complete this form. Your claim form must be
submitted by November 23, 2021. The information in your claim will be used only
for purposes of administering this Settlement (such as to audit and review a
claim for completeness, truth, and accuracy). The amount you will receive
depends on the number of rental days and the number of other claims filed in the
Settlement.

Payments will be issued only if the Court approves the Settlement and the
Effective Date of the Settlement occurs.

First Name *
Last Name *
Email Address *
Mailing Address *
City *
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware
District Of Columbia 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 Armed Forces - Africa, Canada, Europe, Middle East
Armed Forces - Americas Armed Forces - Pacific American Samoa Guam Marshall
Islands Northern Mariana Islands Puerto Rico US Virgin Islands State *
Zip Code *
* Required Fields
Rental Information

Rental Brand Approximate Rental Date Number of Rental Days Reservation Number
Hertz Dollar/Thrifty


+ Add another rental NOTICE: YOU MUST CONFIRM THE TRUTH OF ALL OF THE FOLLOWING,
UNDER PENALTY OF PERJURY, PERJURY IS A CRIME. YOUR CLAIM IS SUBJECT TO
VERIFICATION:
I paid a daily rate for my rental that was higher than what was quoted to me
when I booked online.
I have not received a refund for the rentals described above.
PAYMENT INFORMATION

You have successfully requested a payment. Click here if you would like to
choose a different payment method.


*I SWEAR OR AFFIRM THE TRUTH OF ALL THE INFORMATION ON THIS CLAIM FORM UNDER
PENALTY OF PERJURY UNDER THE LAWS OF THE UNITED STATES, AFFIRM THE JURISDICTION
OF THE BANKRUPTCY COURT OVER ALL MATTERS RELATED TO THE SETTLEMENT AND THIS
CLAIM, AND CONSENT TO ITS AUTHORITY TO ENTER A FINAL ORDER APPROVING THE
SETTLEMENT.
Signature *
Date


YOUR CLAIM FORM HAS BEEN SUBMITTED SUCCESSFULLY.

Please print this page for your records.

Your Claim Details

Submitted Claim ID: Confirmation Code: You will need the above Submitted Claim
ID and Confirmation Code if you would like to edit your Claim at a later time,
so please print this page for your records. CLAIM INFORMATION First Name Last
Name Email Address Mailing Address City State Zip Code



Signature Date

If you have any questions regarding your Claim, please provide the Submitted
Claim ID listed above and email us at Info@MexicoCarRentalSettlement.com

Click here to edit your Claim.

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mexicocarrentalsettlement.com Open in urlscan Pro 18.211.4.112 Public Scan

Form analysis 2 forms found in the DOM

POST

POST

Text Content

mexicocarrentalsettlement.com Open in urlscan Pro
18.211.4.112 Public Scan

Form analysis
2 forms found in the DOM