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Submitted URL: https://fundsdiscovery-now.net/
Effective URL: https://forms.zohopublic.com/sargrp/form/SARGRepresentationAgreement/formperma/QEl40nrefHljSGaqBG6XX5pxfcuPhYkMqIK9SAS8XSY?re...
Submission: On August 22 via api from US — Scanned from NL
Effective URL: https://forms.zohopublic.com/sargrp/form/SARGRepresentationAgreement/formperma/QEl40nrefHljSGaqBG6XX5pxfcuPhYkMqIK9SAS8XSY?re...
Submission: On August 22 via api from US — Scanned from NL
Form analysis 1 forms found in the DOM
<form id="test"><input type="hidden" name="formName" value="SARGRepresentationAgreement" id="formName"><!-- Form Perma will be sent only for PermaUrls -->
<input type="hidden" name="formPerma" value="QEl40nrefHljSGaqBG6XX5pxfcuPhYkMqIK9SAS8XSY" id="formPerma"><input type="hidden" name="referrerName" id="referrerName" value="null"><input type="hidden" name="isPaymentForm" value="false"
id="isPaymentForm"><input type="hidden" name="formType" value="0" id="formType">
<input type="hidden" id="zf_date_format" datelocale="en-GB" name="date_format" value="MM/dd/yyyy"><input type="hidden" name="isDocsPublicForm" value="false" id="isDocsPublicForm">
<input type="hidden" name="formrid" value="" id="formrid">
<input type="hidden" name="resizeform" value="0" id="resizeform">
<div id="zf_utmTrack" style="display: none;"></div>
<div class="templateWrapper" id="formRedirectURL" style="min-height:1070px;">
<ul class="tempHeadBdr formRelative">
<li class="tempHeadContBdr"><span id="logo-formheader" class="formLogo" style="display: none"><img aria-hidden="true" id="logo-formheader-img" src=""></span>
<h2 class="frmTitle" role="heading" aria-level="1"><em>SARG Representation Agreement</em></h2>
<p class="frmDesc">This Agreement is solely in regards to the Payment Card Interchange Fee and Merchant Discount Antitrust Litigation, MDL No. 1720 currently pending in the United States District Court for the Eastern District of New York
(“Action”).</p>
<div class="clearBoth"></div>
</li>
</ul>
<!-- 'FieldElement' class is imported in order to get the key for display name of the component of 'Address' field.
'FormField' class is used to get field type of Zoho CRM field.-->
<div id="formBodyDiv" class="formRelative subContWrap topAlign"><!-- <button elname="openPopUpSubForm" onclick="openPopUp();event.preventDefault()"> Open subform pop up </button> -->
<div class="pBarWrapper bar">
<table id="navigBar" width="100%" border="0" cellspacing="0" cellpadding="0" pagecount="5" navigtype="2" currentpage="1">
<tbody>
<tr class="pBarHeader">
<td onclick="goTo(1);" class="selected currentPTab">
<div class="pBar"></div><em class="pArrow"></em>
</td>
<td onclick="goTo(2);" class="unselected">
<div class="pBar"></div><em class="pArrow"></em>
</td>
<td onclick="goTo(3);" class="unselected">
<div class="pBar"></div><em class="pArrow"></em>
</td>
<td onclick="goTo(4);" class="unselected">
<div class="pBar"></div><em class="pArrow"></em>
</td>
<td onclick="goTo(5);" class="unselected">
<div class="pBar"></div><em class="pArrow"></em>
</td>
</tr>
</tbody>
</table>
</div>
<!-- formFieldWrapper class is used to differantiate form fields and subform fields in themes. Direct children (li) are considered as form fields. Dont change the order of class used. -->
<ul elname="formBodyULName" class="ulNoStyle formFieldWrapper" page_no="1" needpagedata="true">
<!-- i) Private form, ii) Perma, iii) Shared form, iv) Theme preview, v) Current Theme -->
<!-- "isVisible"="false": This 'Admin Only' field must not be shown to user. -->
<!-- "isVisible"="true": Case 1: This is not an 'Admin Only' field. Case 2: This 'Admin Only' field must be shown to user. -->
<!-- Theme Preview, Current Theme - Admin Only fields will be shown. Formula won't be calculated. Field Rules won't be executed. -->
<!-- formMetaData.key=Field link name -->
<!-- Zoho CRM field : "FIELD_LIST" key won't be present. -->
<!--To exclude Section field in rules we are setting comptype as 0 for Section field. That is Section field will not be included in any condition. -->
<li id="Section-li" class="section" elem_type_int="1" tabindex="0" elname="livefield-elem" compname="Section" comptype="0" page_no="1" page_link_name="Page" counteruid="15">
<h2 class="advLabelName">
<div>The information you provide on these first two pages of the form will be added to the agreement, which you will sign in the forthcoming steps.<br></div>
</h2>
<p></p>
</li>
<li class="zfradio tempFrmWrapper oneColumns " style="display:none;" elname="livefield-elem" comptype="13" id="Radio-li" needdata="true" compname="Radio" linkname="Radio" isvisible="false" mandatory="true" page_no="1" page_link_name="Page"
choice_type="radio" counteruid="19">
<label id="Radio-arialabel" class="labelName"><span>Did you have a business at any time between 2004-2019 that accepted Visa or Mastercard?</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<div class="overflow customRadioBtn" role="radiogroup" aria-labelledby="Radio-arialabel">
<span class="multiAttType cusChoiceSpan"> <input aria-describedby="Radio-arialabel hint-Radio" onmousedown="event.preventDefault();" type="radio" id="Radio_1" name="Radio" elname="Radio" class="radioBtnType" value="Yes" formula_val=""
textassign_val="" onchange="ZFLive.prefillFieldLabel(this); ZFLive.hideClosestFieldElemErrorDiv(this);" onclick="selectRadioChoiceOs(this);" checked="" isselected="true">
<label for="Radio_1" class="radioChoice cusChoiceLabel">
<div class="checker"></div><em class="cusChoiceEm">Yes</em>
</label> </span>
<span class="multiAttType cusChoiceSpan"> <input aria-describedby="Radio-arialabel hint-Radio" onmousedown="event.preventDefault();" type="radio" id="Radio_2" name="Radio" elname="Radio" class="radioBtnType" value="No" formula_val=""
textassign_val="" onchange="ZFLive.prefillFieldLabel(this); ZFLive.hideClosestFieldElemErrorDiv(this);" onclick="selectRadioChoiceOs(this);" isselected="false">
<label for="Radio_2" class="radioChoice cusChoiceLabel">
<div class="checker"></div><em class="cusChoiceEm">No</em>
</label> </span>
<div class="clearBoth"></div>
</div>
<p class="errorMessage" elname="error" id="error-Radio"></p>
</div>
<div class="clearBoth"></div>
</li>
<li elname="livefield-elem" comptype="1" id="SingleLine-li" needdata="true" compname="SingleLine" linkname="SingleLine" counteruid="20" isvisible="true" isunique="false" class="tempFrmWrapper small" mandatory="true" page_no="1"
page_link_name="Page" showlabel="true">
<label class="labelName" for="SingleLine-arialabel">
<span>What is/was the legal name of the business?</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<span> <b class="inptCont"> <input id="SingleLine-arialabel" aria-describedby="hint-SingleLine" onkeyup="ZFLive.configureInputMask(this);" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="off" type="text" maxlength="255" name="SingleLine" value="" placeholder="">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b> </span>
<p class="errorMessage" elname="error" id="error-SingleLine"></p>
</div>
<div class="clearBoth"></div>
</li>
<li class="tempFrmWrapper dropdown small zfSelect2CustomCont" elname="livefield-elem" comptype="12" id="Dropdown-li" needdata="true" compname="Dropdown" linkname="Dropdown" isvisible="true" mandatory="false" page_no="1" page_link_name="Page"
showlabel="true" counteruid="22">
<label for="Dropdown-arialabel" id="Dropdown-arialabel-cont" class="labelName">
<span>Select your company type:</span>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<div class="form_selectBox">
<div class="selectArrow"></div><select id="Dropdown-arialabel" aria-describedby="hint-Dropdown" name="Dropdown" onchange="ZFLive.prefillFieldLabel(this); ZFLive.hideClosestFieldElemErrorDiv(this); ZFLive.checkUniqueChoiceFld(this);
" tabindex="-1" class="select2-hidden-accessible" aria-hidden="true">
<option selected="true" value="-Select-">-Select-</option>
<option value="Incorporated (Inc.)" formula_val="" textassign_val="" option_id="1573528000000310645">Incorporated (Inc.)</option>
<option value="Company (Co.)" formula_val="" textassign_val="" option_id="1573528000000310647">Company (Co.)</option>
<option value="Limited Liability Company (LLC)" formula_val="" textassign_val="" option_id="1573528000000310649">Limited Liability Company (LLC)</option>
<option value="Professional Association (P.A.)" formula_val="" textassign_val="" option_id="1573528000000310651">Professional Association (P.A.)</option>
<option value="Professional Corporation (P.C.)" formula_val="" textassign_val="" option_id="1573528000000310653">Professional Corporation (P.C.)</option>
<option value="Limited Company (Ltd.)" formula_val="" textassign_val="" option_id="1573528000000310655">Limited Company (Ltd.)</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 327px;"><span class="selection"><span class="select2-selection select2-selection--single select2FormCont" role="listbox"
aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-Dropdown-arialabel-container Dropdown-arialabel-cont "><span class="select2-selection__rendered" id="select2-Dropdown-arialabel-container"
title="-Select-" role="option">
<div class="select2FormFont drpDwnPlaceholder">-Select-</div>
</span><span class="select2-selection__arrow select2FormArrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</div>
<div elname="liveFieldTempChoiceCont" style="display: none;">
</div>
<p class="errorMessage" elname="error" id="error-Dropdown"></p>
</div>
<div class="clearBoth"></div>
</li>
<li class="tempFrmWrapper dropdown small zfSelect2CustomCont" elname="livefield-elem" comptype="12" id="Dropdown1-li" needdata="true" compname="Dropdown1" linkname="Dropdown1" isvisible="true" mandatory="true" page_no="1"
page_link_name="Page" showlabel="true" counteruid="23">
<label for="Dropdown1-arialabel" id="Dropdown1-arialabel-cont" class="labelName">
<span>What is your relationship with the business? (Title)</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<div class="form_selectBox">
<div class="selectArrow"></div><select id="Dropdown1-arialabel" aria-describedby="hint-Dropdown1" name="Dropdown1" onchange="ZFLive.prefillFieldLabel(this); ZFLive.hideClosestFieldElemErrorDiv(this); ZFLive.checkUniqueChoiceFld(this);
ZFLive.showLiveDropdownOthers(this);" tabindex="-1" class="select2-hidden-accessible" aria-hidden="true">
<option selected="true" value="-Select-">-Select-</option>
<option value="Director" formula_val="" textassign_val="" option_id="1573528000000310657">Director</option>
<option value="Officer" formula_val="" textassign_val="" option_id="1573528000000310659">Officer</option>
<option value="Owner" formula_val="" textassign_val="" option_id="1573528000000310661">Owner</option>
<option value="Shareholder" formula_val="" textassign_val="" option_id="1573528000000310663">Shareholder</option>
<option value="Manager" formula_val="" textassign_val="" option_id="1573528000000310665">Manager</option>
<option value="zfs-others-zfs"> Other</option>
</select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: 327px;"><span class="selection"><span class="select2-selection select2-selection--single select2FormCont" role="listbox"
aria-haspopup="true" aria-expanded="false" tabindex="0" aria-labelledby="select2-Dropdown1-arialabel-container Dropdown1-arialabel-cont "><span class="select2-selection__rendered" id="select2-Dropdown1-arialabel-container"
title="-Select-" role="option">
<div class="select2FormFont drpDwnPlaceholder">-Select-</div>
</span><span class="select2-selection__arrow select2FormArrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</div>
<div elname="allow-others-div" class="dropotherDiv" style="display: none;">
<b class="inptCont">
<input name="allow-others-text" aria-labelledby="Dropdown1-arialabel-cont" aria-describedby="hint-Dropdown1" type="text" maxlength="150" onfocusout="ZFLive.prefillFieldLabel(this);">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01 icon_ofSerchIcn" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01 OfDelete_icon" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b>
</div>
<div elname="liveFieldTempChoiceCont" style="display: none;">
</div>
<p class="errorMessage" elname="error" id="error-Dropdown1"></p>
</div>
<div class="clearBoth"></div>
</li>
<li elname="livefield-elem" comptype="1" id="SingleLine1-li" needdata="true" compname="SingleLine1" linkname="SingleLine1" counteruid="21" isvisible="true" isunique="false" class="tempFrmWrapper small" mandatory="true" page_no="1"
page_link_name="Page" showlabel="true">
<label class="labelName" for="SingleLine1-arialabel">
<span>Business Tax Identification Number (TIN or EIN)</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<span> <b class="inptCont"> <input id="SingleLine1-arialabel" aria-describedby="hint-SingleLine1" onkeyup="ZFLive.configureInputMask(this);" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="off" type="text" maxlength="255" name="SingleLine1" value="" placeholder="xxxxxxxxxx">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b> </span>
<p class="errorMessage" elname="error" id="error-SingleLine1"></p>
<p class="instruction instrSpace" elname="hint" id="hint-SingleLine1"> 9-Digits Numbers Only Please </p>
</div>
<div class="clearBoth"></div>
</li>
<li elname="livefield-elem" comptype="1" id="SingleLine2-li" needdata="true" compname="SingleLine2" linkname="SingleLine2" counteruid="26" isvisible="true" isunique="false" class="tempFrmWrapper small" mandatory="false" page_no="1"
page_link_name="Page" showlabel="true">
<label class="labelName" for="SingleLine2-arialabel">
<span>Estimated annual credit card sales</span>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<span> <b class="inptCont"> <input id="SingleLine2-arialabel" aria-describedby="hint-SingleLine2" onkeyup="ZFLive.configureInputMask(this);" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="off" type="text" maxlength="255" name="SingleLine2" value="" placeholder="">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b> </span>
<p class="errorMessage" elname="error" id="error-SingleLine2"></p>
</div>
<div class="clearBoth"></div>
</li>
<li elname="livefield-elem" comptype="1" id="SingleLine5-li" needdata="true" compname="SingleLine5" linkname="SingleLine5" counteruid="60" isvisible="false" isunique="false" class="tempFrmWrapper small" style="display:none;" mandatory="false"
page_no="1" page_link_name="Page" showlabel="true">
<label class="labelName" for="SingleLine5-arialabel">
<span>Referral code</span>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<span> <b class="inptCont"> <input id="SingleLine5-arialabel" aria-describedby="hint-SingleLine5" onkeyup="ZFLive.configureInputMask(this);" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="off" type="text" maxlength="255" name="SingleLine5" value="FirstGen" placeholder="">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b> </span>
<p class="errorMessage" elname="error" id="error-SingleLine5"></p>
<p class="instruction instrSpace" elname="hint" id="hint-SingleLine5"> If you have a Referral code, please add it here. </p>
</div>
<div class="clearBoth"></div>
</li>
<li elname="livefield-elem" comptype="1" id="SingleLine7-li" needdata="true" compname="SingleLine7" linkname="SingleLine7" counteruid="62" isvisible="false" isunique="false" class="tempFrmWrapper small" style="display:none;" mandatory="false"
page_no="1" page_link_name="Page" showlabel="true">
<label class="labelName" for="SingleLine7-arialabel">
<span>p</span>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<span> <b class="inptCont"> <input id="SingleLine7-arialabel" aria-describedby="hint-SingleLine7" onkeyup="ZFLive.configureInputMask(this);" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="off" type="text" maxlength="255" name="SingleLine7" value="963025" placeholder="">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b> </span>
<p class="errorMessage" elname="error" id="error-SingleLine7"></p>
</div>
<div class="clearBoth"></div>
</li>
<li elname="livefield-elem" comptype="1" id="SingleLine6-li" needdata="true" compname="SingleLine6" linkname="SingleLine6" counteruid="61" isvisible="false" isunique="false" class="tempFrmWrapper small" style="display:none;" mandatory="false"
page_no="1" page_link_name="Page" showlabel="true">
<label class="labelName" for="SingleLine6-arialabel">
<span>Closer</span>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<span> <b class="inptCont"> <input id="SingleLine6-arialabel" aria-describedby="hint-SingleLine6" onkeyup="ZFLive.configureInputMask(this);" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="off" type="text" maxlength="255" name="SingleLine6" value="First Gen" placeholder="">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b> </span>
<p class="errorMessage" elname="error" id="error-SingleLine6"></p>
</div>
<div class="clearBoth"></div>
</li>
<li elname="livefield-elem" comptype="1" id="SingleLine3-li" needdata="true" compname="SingleLine3" linkname="SingleLine3" counteruid="41" isvisible="false" isunique="false" class="tempFrmWrapper small" style="display:none;" mandatory="false"
page_no="1" page_link_name="Page" showlabel="true">
<label class="labelName" for="SingleLine3-arialabel">
<span>Lead Source</span>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<span> <b class="inptCont"> <input id="SingleLine3-arialabel" aria-describedby="hint-SingleLine3" onkeyup="ZFLive.configureInputMask(this);" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="off" type="text" maxlength="255" name="SingleLine3" value="sargrp.com" placeholder="">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b> </span>
<p class="errorMessage" elname="error" id="error-SingleLine3"></p>
</div>
<div class="clearBoth"></div>
</li>
<li elname="livefield-elem" comptype="1" id="SingleLine4-li" needdata="true" compname="SingleLine4" linkname="SingleLine4" counteruid="42" isvisible="false" isunique="false" class="tempFrmWrapper small" style="display:none;" mandatory="true"
page_no="1" page_link_name="Page" showlabel="true">
<label class="labelName" for="SingleLine4-arialabel">
<span>Lead Status</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<span> <b class="inptCont"> <input id="SingleLine4-arialabel" aria-describedby="hint-SingleLine4" onkeyup="ZFLive.configureInputMask(this);" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="off" type="text" maxlength="255" name="SingleLine4" value="Not Contacted" placeholder="">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b> </span>
<p class="errorMessage" elname="error" id="error-SingleLine4"></p>
</div>
<div class="clearBoth"></div>
</li>
<li isunique="false" class="tempFrmWrapper small" style="display:none;" elname="livefield-elem" comptype="3" id="Number-li" needdata="true" compname="Number" linkname="Number" isvisible="false" mandatory="false" unit_position="2" page_no="1"
page_link_name="Page" summary_type="0" showlabel="true" counteruid="56" need_reconf="false">
<label class="labelName" for="Number-arialabel">
<span>Percentage Fee</span>
<span class="sr-only"></span>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div elname="tempContDiv" class="tempContDiv numberContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<span> <b class="inptCont"> <input id="Number-arialabel" aria-describedby="hint-Number" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="off" type="text" inputmode="numeric" maxlength="18" name="Number" value="30" placeholder="">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b> </span>
<span class="symbol" name="field_unit_after" elname="field_unit_span" aria-hidden="true"></span>
<p class="errorMessage" elname="error" id="error-Number"></p>
</div>
<div class="clearBoth"></div>
</li>
</ul>
<!-- formFieldWrapper class is used to differantiate form fields and subform fields in themes. Direct children (li) are considered as form fields. Dont change the order of class used. -->
<ul elname="formBodyULName" class="ulNoStyle formFieldWrapper" page_no="2" needpagedata="true" style="display:none;">
<!-- i) Private form, ii) Perma, iii) Shared form, iv) Theme preview, v) Current Theme -->
<!-- "isVisible"="false": This 'Admin Only' field must not be shown to user. -->
<!-- "isVisible"="true": Case 1: This is not an 'Admin Only' field. Case 2: This 'Admin Only' field must be shown to user. -->
<!-- Theme Preview, Current Theme - Admin Only fields will be shown. Formula won't be calculated. Field Rules won't be executed. -->
<!-- formMetaData.key=Field link name -->
<!-- Zoho CRM field : "FIELD_LIST" key won't be present. -->
<li class="tempFrmWrapper name namemedium zfSelect2CustomCont" elname="livefield-elem" comptype="7" needdata="true" id="Name-li" compname="Name" linkname="Name" isvisible="true" mandatory="true" page_no="2" page_link_name="Page1"
regex_type="0" showlabel="true" counteruid="27">
<label class="labelName" id="Name-arialabel">
<span>Your Name</span>
<em class="important" aria-hidden="true">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv twoType" elemname="fieldContentDiv">
<div class="nameWrapper">
<span elname="compEachElem">
<span class="sr-only" elname="ariaReqSpan" id="ariarequired-Name0">Required</span>
<input aria-labelledby="Name-arialabel aria-showelemslabel-Name0 ariarequired-Name0" aria-describedby="hint-Name" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="given-name" type="text" maxlength="255" elname="First"
name="Name" complink="Name_First" value="" mandatory="true" placeholder="">
<label id="aria-showelemslabel-Name0" elname="formSubInfoText" class="formSubInfoText">First Name</label>
</span>
<span elname="compEachElem">
<span class="sr-only" elname="ariaReqSpan" id="ariarequired-Name1">Required</span>
<input aria-labelledby="Name-arialabel aria-showelemslabel-Name1 ariarequired-Name1" aria-describedby="hint-Name" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="family-name" type="text" maxlength="255" elname="Last"
name="Name" complink="Name_Last" value="" mandatory="true" placeholder="">
<label id="aria-showelemslabel-Name1" elname="formSubInfoText" class="formSubInfoText">Last Name</label>
</span>
<div class="clearBoth"></div>
</div>
<p class="errorMessage" elname="error" id="error-Name"></p>
</div>
<div class="clearBoth"></div>
</li>
<li isunique="false" class="tempFrmWrapper email small" elname="livefield-elem" comptype="9" id="Email-li" needdata="true" compname="Email" linkname="Email" isvisible="true" mandatory="true" page_no="2" page_link_name="Page1" showlabel="true"
counteruid="28" domain_option="0" need_reconf="true">
<label class="labelName" for="Email-arialabel">
<span>Email</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<span elname="livefield-email-elem"> <b class="inptCont">
<input inputmode="email" id="Email-arialabel" aria-describedby="hint-Email" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="email" type="text" maxlength="255" name="Email" value="" placeholder="">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b>
</span>
<span elname="livefield-reconf-elem" class="confrmEmailDiv"> <input inputmode="email" onkeyup="ZFLive.validateFieldEquality(this,false);" onblur="ZFLive.validateFieldEquality(this,true);" placeholder="Confirm Email" autocomplete="off"
type="text" maxlength="255" name="Email-reconf">
<p elname="reconf-error" class="errorMessage" id="error-Email-reconf" style="display: none;"></p>
</span>
<p class="errorMessage" elname="error" id="error-Email" style="display: none;"></p>
</div>
<div class="clearBoth"></div>
</li>
<li isunique="false" class="tempFrmWrapper phone small" elname="livefield-elem" comptype="11" id="PhoneNumber-li" needdata="true" compname="PhoneNumber" linkname="PhoneNumber" isvisible="true" mandatory="true" page_no="2"
page_link_name="Page1" showlabel="true" counteruid="29" need_reconf="false">
<label id="PhoneNumber-arialabel" class="labelName">
<span>Phone</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elname="phoneFormatElem" phoneformat="INTERNATIONAL" elemname="fieldContentDiv" incwebhk_name="fieldContentDiv">
<div elname="phoneFld" name="phone-elements">
<b class="inptCont">
<input name="PhoneNumber" aria-describedby="hint-PhoneNumber" aria-labelledby="PhoneNumber-arialabel" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="tel" id="PhoneNumber" type="text" elname="countrycode" maxlength="20" value="" iscodeenabled="false" phoneformattype="1" placeholder="">
<div elname="incWebhookSearchDiv" style="display:none"><svg class="icon icon-Serch-Icon01" elname="search-icon"><use xlink:href="#icon-fetch-Icon-01"></use></svg>
<svg class="icon icon-Close-Icon01" elname="clear-icon"><use xlink:href="#icon-close"></use></svg></div></b>
</div>
<p class="errorMessage" elname="error" id="error-PhoneNumber"></p>
<script type="module">
if (false == true && (true)) {
var allowedCountryList = [];
var ipBasedCurrentCountry = null;
var defaultCountry = ""; // No I18N
var keyId = $("#PhoneNumber");
var keyIdConf = ("#" + "PhoneNumber" + "-reconf"); // No I18N
var listofcountries = [],
hasCode = false;
var initialCountry = "auto"; // No I18N
var countryCodeProps = jQuery.extend(true, {}, ZFPhone.countryCodeProps);
var isRtlEnabled = false;
var txtDir = "1"; // No I18N
if (txtDir != null && txtDir != undefined) {
if (txtDir == 2) {
isRtlEnabled = true;
}
}
countryCodeProps.isRtl = isRtlEnabled;
if (defaultCountry != "") {
defaultCountry = countryUniqueCode[""]; // No I18N
}
if (allowedCountryList.length > 0) {
var phoneVal = ""; // No I18N
var codeVal = ""; // No I18N
for (var itr = 0; itr < allowedCountryList.length; itr++) {
if (codeVal != "" && codelist[allowedCountryList[itr]] == codeVal && !hasCode) {
phoneVal = codeVal + phoneVal;
hasCode = true;
}
listofcountries[itr] = countryUniqueCode[allowedCountryList[itr]];
}
countryCodeProps.onlyCountries = listofcountries;
if ("live" == 'live') {
if (jQuery.inArray(defaultCountry, listofcountries) !== -1) {
initialCountry = defaultCountry;
} else if (ipBasedCurrentCountry !== null && ipBasedCurrentCountry != "null" && ipBasedCurrentCountry != "-" && jQuery.inArray(ipBasedCurrentCountry, listofcountries) != -1) { // No I18N
initialCountry = ipBasedCurrentCountry;
}
} else {
$("#PhoneNumber").val(phoneVal);
if ("false" == "true") {
$(keyIdConf).val(phoneVal); // No I18N
}
}
} else if ("live" == 'live') { // No I18N
if (defaultCountry != "") {
initialCountry = defaultCountry;
} else if (ipBasedCurrentCountry !== null && ipBasedCurrentCountry != "null" && ipBasedCurrentCountry != "-") { // No I18N
initialCountry = ipBasedCurrentCountry;
}
}
if ($(keyId).parents("ul").attr("elname") != "subFormFieldsCloneUl") {
countryCodeProps.initialCountry = initialCountry;
$(keyId).intlTelInput(countryCodeProps);
$(keyIdConf).intlTelInput(countryCodeProps); // No I18N
if ("live" == 'live') {
$(keyId).intlTelInput("setNumber", ""); // No I18N
}
if ("live" == 'edit' && "" != null && "" != "") {
$(keyId).intlTelInput("setCountry", ""); // No I18N
$(keyIdConf).intlTelInput("setCountry", ""); // No I18N
}
}
$(keyId).attr({
"initCountry": initialCountry,
"countryList": listofcountries
}); // No I18N
//$("#PhoneNumber") is used instead of variable keyId, since event get attached only to the last dom element instead of all elements.
setCountryCodePropsForFlds(("#" + "PhoneNumber"), isRtlEnabled); // No I18N
if ("false" == "true") {
setCountryCodePropsForFlds(("#" + "PhoneNumber" + "-reconf"), isRtlEnabled); // No I18N
}
}
</script>
</div>
<div class="clearBoth"></div>
</li>
<li class="tempFrmWrapper address addrlarge zfSelect2CustomCont" mode="live" elname="livefield-elem" comptype="8" needdata="true" id="Address-li" compname="Address" linkname="Address" isvisible="true" mandatory="true" page_no="2"
page_link_name="Page1" showlabel="true" statefldtype="1" counteruid="30">
<div class="arrowNav"></div>
<label class="labelName" id="Address-arialabel">
<span>Address to Send Payment if Eligible</span>
<em class="important" aria-hidden="true">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv address" elemname="fieldContentDiv">
<div class="addrCont">
<!-- <input value=>-->
<span class="addOne" elname="compEachElem">
<span class="sr-only" elname="ariaReqSpan" id="ariarequired-Address0">Required</span>
<input aria-labelledby="Address-arialabel aria-showelemslabel-Address0 ariarequired-Address0" aria-describedby="hint-Address" name="Address" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="address-line1" type="text"
maxlength="255" complink="Address_AddressLine1" value="" mandatory="true" placeholder="">
<!-- Display name of 'AddressLine1' component of 'Address' field. -->
<label class="formSubInfoText" elname="formSubInfoText" id="aria-showelemslabel-Address0">Street Address</label>
</span>
<!-- <input value=>-->
<!-- <input value=>-->
<span class="flLeft addtwo" elname="compEachElem">
<span class="sr-only" elname="ariaReqSpan" id="ariarequired-Address2">Required</span>
<input aria-labelledby="Address-arialabel aria-showelemslabel-Address2 ariarequired-Address2" aria-describedby="hint-Address" name="Address" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="address-level2" type="text"
maxlength="255" complink="Address_City" value="" mandatory="true" placeholder="">
<!-- Display name of 'City' component of 'Address' field. -->
<label class="formSubInfoText" elname="formSubInfoText" id="aria-showelemslabel-Address2">City</label>
</span>
<!-- <input value=>-->
<span class="flLeft addtwo" elname="compEachElem">
<span class="sr-only" elname="ariaReqSpan" id="ariarequired-Address3">Required</span>
<input aria-labelledby="Address-arialabel aria-showelemslabel-Address3 ariarequired-Address3" aria-describedby="hint-Address" name="Address" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="address-level1" type="text"
maxlength="255" complink="Address_Region" value="" mandatory="true" placeholder="">
<!--</div>-->
<!-- Display name of 'Region' component of 'Address' field. -->
<label class="formSubInfoText" elname="formSubInfoText" id="aria-showelemslabel-Address3">State</label>
</span>
<!-- <input value=>-->
<span class="flLeft addtwo" elname="compEachElem">
<span class="sr-only" elname="ariaReqSpan" id="ariarequired-Address4">Required</span>
<input aria-labelledby="Address-arialabel aria-showelemslabel-Address4 ariarequired-Address4" aria-describedby="hint-Address" name="Address" onfocusout="ZFLive.validateFieldConstraint(this);" autocomplete="postal-code" type="text"
maxlength="255" complink="Address_ZipCode" value="" mandatory="true" placeholder="">
<!-- Display name of 'ZipCode' component of 'Address' field. -->
<label class="formSubInfoText" elname="formSubInfoText" id="aria-showelemslabel-Address4">Zip</label>
</span>
<!-- <input value=>-->
<div class="clearBoth"></div>
<p class="errorMessage" elname="error" id="error-Address"></p>
</div>
</div>
<div class="clearBoth"></div>
<script type="module">
$(function() {
var mode = "live"; // No I18N
if (mode == "edit") { // No I18N
var selectedCountry = ""; // No I18N
var selectedCountryNonEncoded = ""; // No I18N
var compname = "Address"; //No I18N
var linkname;
if (compname.indexOf("_") != -1) {
var splittedArr = compname.split("_");
linkname = splittedArr[0];
} else {
linkname = compname;
}
var countryDropdown = $("#Address-li").find('select[complink=' + linkname + ZFFormField.ADDRESS.COUNTRY.KEY + ']');
if (selectedCountry.length > 0 && (typeof($(countryDropdown).find('option:selected').val()) == 'undefined' || $(countryDropdown).find('option:selected').val().toLowerCase() != selectedCountryNonEncoded.toLowerCase())) { // No I18N
$(countryDropdown).append($("<option></option>").attr("value", selectedCountryNonEncoded).html(selectedCountry).hide()); // No I18N
$(countryDropdown).val(selectedCountryNonEncoded).change();
}
}
});
</script>
</li>
</ul>
<!-- formFieldWrapper class is used to differantiate form fields and subform fields in themes. Direct children (li) are considered as form fields. Dont change the order of class used. -->
<ul elname="formBodyULName" class="ulNoStyle formFieldWrapper" page_no="3" needpagedata="true" style="display:none;">
<!-- i) Private form, ii) Perma, iii) Shared form, iv) Theme preview, v) Current Theme -->
<!-- "isVisible"="false": This 'Admin Only' field must not be shown to user. -->
<!-- "isVisible"="true": Case 1: This is not an 'Admin Only' field. Case 2: This 'Admin Only' field must be shown to user. -->
<!-- Theme Preview, Current Theme - Admin Only fields will be shown. Formula won't be calculated. Field Rules won't be executed. -->
<!-- formMetaData.key=Field link name -->
<!-- Zoho CRM field : "FIELD_LIST" key won't be present. -->
<!--To exclude Section field in rules we are setting comptype as 0 for Section field. That is Section field will not be included in any condition. -->
<li id="Section1-li" class="section" elem_type_int="1" tabindex="0" elname="livefield-elem" compname="Section1" comptype="0" page_no="3" page_link_name="Page2" counteruid="33">
<h2>Please review and sign the contract below.</h2>
<p></p>
</li>
<!--To exclude Html field in rules we are setting comptype as 0 for Html field. That is Html field will not be included in any condition. -->
<li tabindex="0" id="HtmlText-li" class="tempFrmWrapper note" elem_type_int="5" elname="livefield-elem" compname="HtmlText" comptype="0" page_no="3" page_link_name="Page2" counteruid="34">
<label class="descFld" elname="descFldLabel" tabindex="0">
<div class="WordSection1">
<h1 style="margin-top: 3.7pt; text-align: center" class="align-center">
<u style=""><span class="size" style="font-size: 18.6667px">AGREEMENT</span><span style="letter-spacing: 0.85pt"><span class="size" style="font-size: 18.6667px"> </span></span><span class="size" style="font-size: 18.6667px">FOR</span><span style="letter-spacing: 0.15pt"><span class="size" style="font-size: 18.6667px"> </span></span><span class="size" style="font-size: 18.6667px">REPRESENTATION</span><span style="letter-spacing: 0.2pt"><span class="size" style="font-size: 18.6667px"> </span></span><span class="size" style="font-size: 18.6667px">&</span><span style="letter-spacing: 0.15pt"><span class="size" style="font-size: 18.6667px"> </span></span><span class="size" style="font-size: 18.6667px">AUTHORITY</span><span style="letter-spacing: 0.15pt"><span class="size" style="font-size: 18.6667px"> </span></span><span class="size" style="font-size: 18.6667px">TO</span><span style="letter-spacing: 0.55pt"><span class="size" style="font-size: 18.6667px"> </span></span><span style="letter-spacing: -0.1pt"><span class="size" style="font-size: 18.6667px">REPRESENT</span></span></u><span
class="size" style="font-size: 18.6667px"><br></span></h1>
<p style="margin-top: 0px" class="MsoBodyText"><b style=""><span class="size" style="font-size: 10pt"> </span></b><br></p>
<p style="margin: 0px 7.65pt 0.0001pt 10.65pt; text-align: justify; text-indent: 0.5in; line-height: 95%" class="MsoBodyText">This Agreement for Representation and Authority to Represent (collectively “Agreement”) is entered into by and
between the client identified in the signature block below (“Client”) and<span style="letter-spacing: 2pt"> </span><b style="">Serendipity Asset Recovery Group, LLC. </b>(hereinafter “SARG”).<br></p>
<p style="margin-top: 0px" class="MsoBodyText"><span class="size" style="font-size: 10pt"> </span><br></p>
<p style="line-height: 95%; margin-top: 0px" class="MsoListParagraph"><span style="">1.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Scope of Representation</u>. </b>Client may be a class member entitled to a payment in a settled class action lawsuit styled:
<i style="">In re Payment Card Interchange Fee and Merchant Discount Antitrust Litigation</i>,<span style="letter-spacing: 2pt"> </span>MDL<span style="letter-spacing: 2pt"> </span>No.<span style="letter-spacing: 2pt">
</span>1720<span style="letter-spacing: 2pt"> </span>currently<span style="letter-spacing: 2pt"> </span>pending<span style="letter-spacing: 2pt"> </span>in<span style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt">
</span>United<span style="letter-spacing: 2pt"> </span>States<span style="letter-spacing: 2pt"> </span>District<span style="letter-spacing: 2pt"> </span>Court<span style="letter-spacing: 2pt"> </span>for<span
style="letter-spacing: 2pt"> </span>the Eastern District of New York (“Action”). The Action concerns excessive fees charged to businesses for accepting Visa and Mastercard cards in violation of antitrust laws. To obtain a payment
from the settlement, class members must submit valid claims (“Claims” or “Claim”) to the court-assigned settlement administrator, Epiq Class Action & Claims<span style="letter-spacing: 2pt"> </span>Solutions, Inc. (“Settlement
Administrator”). The Claim forms are not yet available for completion and submission by class members. Once available, failure to submit a valid Claim will result in class members releasing their Claims without receiving payment in
return. By this Agreement, Client engages SARG to<b style=""> </b>serve as Client’s agent, and sole representative, to work with the Settlement Administrator to determine if Client is qualified, and if qualified, to submit<span
style="letter-spacing: 2pt"> </span>Client’s Claim on Client’s behalf.<br></p>
<div><br></div>
<div><span style="">2.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">SARG'S Fees and Payment to Client</u>. </b>In consideration for representing Client and providing the services outlined in this Agreement, including those in paragraphs 4 and 10,
<b style=""><i style="">Client agrees to pay SARG a fee of 30% of Client’s gross dollar recovery from the settlement. If<span style="letter-spacing: 4pt"> </span>Client<span style="letter-spacing: -0.45pt"> </span>does<span style="letter-spacing: -0.45pt"> </span>not<span style="letter-spacing: -0.45pt"> </span>qualify<span style="letter-spacing: -0.45pt"> </span>for<span style="letter-spacing: -0.45pt"> </span>the<span style="letter-spacing: -0.45pt"> </span>settlement,<span style="letter-spacing: -0.45pt"> </span>or<span style="letter-spacing: -0.45pt"> </span>if<span style="letter-spacing: -0.45pt"> </span>there<span style="letter-spacing: -0.05pt"> </span>is<span style="letter-spacing: -0.05pt"> </span>otherwise<span style="letter-spacing: -0.1pt"> </span>no<span style="letter-spacing: -0.05pt"> </span>recovery,<span style="letter-spacing: -0.05pt"> </span>Client<span style="letter-spacing: -0.05pt"> </span>shall<span style="letter-spacing: -0.1pt"> </span>not<span style="letter-spacing: -0.1pt"> </span>be responsible<span style="letter-spacing: 2pt"> </span>for<span style="letter-spacing: 1.9pt"> </span>the<span style="letter-spacing: 2pt"> </span>payment<span style="letter-spacing: 2pt"> </span>of<span style="letter-spacing: 2pt"> </span>any<span style="letter-spacing: 2pt"> </span>fees or any costs to SARG.</i></b><br>
</div>
<div><b style=""><i style=""><span class="size" style="font-size: 9.5pt"> </span></i></b><br></div>
<p style="line-height: 95%; margin-top: 0px" class="MsoListParagraph"><span style="">3.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Investigation / Termination for Non-Eligibility</u>. </b>Following Client’s engagement of SARG, SARG will investigate and confirm whether Client is a class member eligible for Claim
submission and payment from the settlement. If SARG determines Client is not eligible, or if SARG otherwise chooses not to submit a Claim for Client, SARG<span style="letter-spacing: -0.55pt"> </span>may, at any time, terminate this
agreement and withdraw from representing Client. In the event <span style="letter-spacing: 0.45pt">SARG </span>terminates the Agreement, SARG will provide<span style="letter-spacing: 2pt"> </span>email notice<span
style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt"> </span>Client advising of its withdrawal. If SARG terminates this agreement, Client<span style="letter-spacing: 2pt"> </span>will not be responsible for the
payment of any fees or any costs expended by SARG.<br></p>
<div><br></div>
<p style="margin-top: 0px" class="MsoBodyText"><span class="size" style="font-size: 10pt"> </span><span style="">4.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Scope of Engagement / Claim Submission / Authority to Represent</u></b>. Client has retained SARG to work with the Settlement Administrator (Class Counsel and the Court to the extent
necessary or required) to determine if Client qualifies for the settlement, and if qualified, to handle the entirety of the Claim submission process on Client’s behalf. Client acknowledges there is significant value to Client to have
SARG represent Client in this capacity. Client acknowledges that there is no legal requirement that class members retain a lawyer to file claims on their behalf, <span style="letter-spacing: 0.65pt">and </span>Client has selected<span
style="letter-spacing: 2pt"> </span>and<span style="letter-spacing: 2pt"> </span>engaged SARG to handle<span style="letter-spacing: 2pt"> </span>Client’s<span style="letter-spacing: 2pt"> </span>Claim<span
style="letter-spacing: 2pt"> </span>and<span style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt"> </span>represent<span style="letter-spacing: 2pt"> </span>Client’s interest in this Action.<span
style="letter-spacing: -0.15pt"> </span>Client<span style="letter-spacing: -0.15pt"> </span>understands<span style="letter-spacing: -0.1pt"> </span>the<span style="letter-spacing: -0.1pt"> </span>Settlement<span
style="letter-spacing: -0.15pt"> </span>Administrator<span style="letter-spacing: -0.15pt"> </span>and<span style="letter-spacing: -0.1pt"> </span>Class<span style="letter-spacing: -0.15pt"> </span>Counsel<span
style="letter-spacing: -0.1pt"> </span>are<span style="letter-spacing: -0.1pt"> </span>available<span style="letter-spacing: -0.15pt"> </span>at<span style="letter-spacing: 2pt"> </span>no cost to Client<span
style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt"> </span>assist<span style="letter-spacing: 2pt"> </span>during<span style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt">
</span>claims-filing<span style="letter-spacing: 2pt"> </span>period.<span style="letter-spacing: 2pt"> </span>Notwithstanding,<span style="letter-spacing: 2pt"> </span>Client<span style="letter-spacing: 2pt"> </span>prefers<span
style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt"> </span>have SARG represent Client. Client grants SARG full,<span style="letter-spacing: -0.05pt"> </span>complete, and exclusive authority to communicate with
the Settlement<span style="letter-spacing: 2pt"> </span>Administrator,<span style="letter-spacing: 2pt"> </span>Class<span style="letter-spacing: 2pt"> </span>Counsel,<span style="letter-spacing: 2pt"> </span>and<span
style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt"> </span>Court<span style="letter-spacing: 2pt"> </span>on<span style="letter-spacing: 2pt"> </span>Client’s<span style="letter-spacing: 2pt">
</span>behalf,<span style="letter-spacing: 2pt"> </span>and<span style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt"> </span>make<span style="letter-spacing: 2pt"> </span>all decisions<span
style="letter-spacing: -0.8pt"> </span>related<span style="letter-spacing: -0.05pt"> </span>to the Action and the settlement on<span style="letter-spacing: -0.8pt"> </span>Client’s<span style="letter-spacing: -0.7pt">
</span>behalf.<span style="letter-spacing: -0.6pt"> </span>Client authorizes SARG to instruct the Settlement Administrator, Class Counsel, and the Court to communicate exclusively and directly with SARG on<span
style="letter-spacing: 2pt"> </span>Client’s<span style="letter-spacing: 2pt"> </span>behalf.<span style="letter-spacing: 2pt"> </span>Client<span style="letter-spacing: 2pt"> </span>authorizes<span style="letter-spacing: 2pt">
</span>SARG<span style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt"> </span>instruct the<span style="letter-spacing: 2pt"> </span>Settlement Administrator<span style="letter-spacing: 2pt"> </span>to send Client’s
Claim form to SARG on Client’s behalf (in lieu of the Claim form being sent to Client) to eliminate the possibility Client fails to receive or review the Claim form, and to ensure Client timely submits<span
style="letter-spacing: -0.15pt"> </span>a<span style="letter-spacing: -0.15pt"> </span>completed<span style="letter-spacing: -0.1pt"> </span>Claim.<span style="letter-spacing: -0.15pt"> </span>Client<span
style="letter-spacing: -0.15pt"> </span>authorizes<span style="letter-spacing: -0.15pt"> </span>SARG<span style="letter-spacing: -0.15pt"> </span>to<span style="letter-spacing: -0.15pt"> </span>prepare,<span
style="letter-spacing: -0.15pt"> </span>complete,<span style="letter-spacing: -0.15pt"> </span>and<span style="letter-spacing: -0.15pt"> </span>submit<span style="letter-spacing: -0.15pt"> </span>Client’s<span
style="letter-spacing: -0.15pt"> </span>Claim<span style="letter-spacing: -0.15pt"> </span>to the Settlement Administrator and to communicate as necessary with the Settlement Administrator, Class Counsel, or the Court about Client,
Client’s Claim, and the Claim process. SARG may respond<span style="letter-spacing: 2pt"> </span>to any follow-up requests from the Settlement Administrator or others for additional information or documentation necessary to
substantiate Client’s Claim or to support the amount of the proposed Claim payment amount. At SARG’s sole discretion, without consultation with Client, SARG<span style="letter-spacing: 2pt"> </span>may accept,<span
style="letter-spacing: 2pt"> </span>contest<span style="letter-spacing: 2pt"> </span>and/or<span style="letter-spacing: 2pt"> </span>negotiate<span style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt">
</span>Claim<span style="letter-spacing: 2pt"> </span>payment<span style="letter-spacing: 2pt"> </span>amount<span style="letter-spacing: 2pt"> </span>on<span style="letter-spacing: 2pt"> </span>Client’s<span
style="letter-spacing: 2pt"> </span>behalf.<span style="letter-spacing: 2pt"> </span>SARG<span style="letter-spacing: 2pt"> </span>shall <span style="letter-spacing: -0.1pt">instruct</span><span style="letter-spacing: 0.15pt">
</span><span style="letter-spacing: -0.1pt">Settlement</span><span style="letter-spacing: -0.35pt"> </span><span style="letter-spacing: -0.1pt">Administrator</span><span style="letter-spacing: -0.35pt"> </span><span
style="letter-spacing: -0.1pt">as</span><span style="letter-spacing: -0.35pt"> </span><span style="letter-spacing: -0.1pt">to</span><span style="letter-spacing: -0.35pt"> </span><span style="letter-spacing: -0.1pt">where</span><span
style="letter-spacing: -0.25pt"> </span><span style="letter-spacing: -0.1pt">and</span><span style="letter-spacing: -0.35pt"> </span><span style="letter-spacing: -0.1pt">the</span><span style="letter-spacing: -0.7pt"> </span><span
style="letter-spacing: -0.1pt">means</span><span style="letter-spacing: -0.3pt"> </span><span style="letter-spacing: -0.1pt">(check/wire)</span><span style="letter-spacing: -0.35pt"> </span><span
style="letter-spacing: -0.1pt">to</span><span style="letter-spacing: -0.35pt"> </span><span style="letter-spacing: -0.1pt">send</span><span style="letter-spacing: -0.25pt"> </span><span
style="letter-spacing: -0.1pt">Client’s</span><span style="letter-spacing: -0.35pt"> </span><span style="letter-spacing: -0.1pt">Claim</span><span style="letter-spacing: -0.35pt"> </span><span style="letter-spacing: -0.1pt">payment
</span>proceeds. SARG has the authority to sign Client’s signature on any document needed to present or support the Claim to the Settlement Administrator, or on any<span style="letter-spacing: 2pt"> </span>check<span
style="letter-spacing: -0.15pt"> </span>issued to Client for Client’s Claim payment proceeds for purposes of distributing Client’s share and SARG's fees to each accordingly.<br></p>
<div><br></div>
<div><span style="">5.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Client’s Payment</u></b>. Client acknowledges Client’s payment will be a <i style="">pro rata </i>share of the remaining money in the settlement fund after payment of Class<span
style="letter-spacing: 2pt"> </span>Counsel’s attorneys’ fees and costs, Settlement Administration costs, service awards to the Action’s class representatives, and payments allocated to those class members who opted-out of the
settlement. It is not possible to know the amount of<span style="letter-spacing: 2pt"> </span>Client’s payment<span style="letter-spacing: 2pt"> </span>until<span style="letter-spacing: 2pt"> </span>all<span
style="letter-spacing: 2pt"> </span>valid<span style="letter-spacing: 2pt"> </span>claims<span style="letter-spacing: 2pt"> </span>for all<span style="letter-spacing: 2pt"> </span>class<span style="letter-spacing: 2pt">
</span>members<span style="letter-spacing: 2pt"> </span>are<span style="letter-spacing: 2pt"> </span>submitted. It<span style="letter-spacing: 2pt"> </span>is<span style="letter-spacing: 2pt"> </span>the intention of the parties to
have the Settlement Administrator pay Client directly for its share of the settlement proceeds (after deduction for attorneys’ fees) and to pay SARG directly for its fees. Client agrees this agreement<span style="letter-spacing: 2pt">
</span>shall<span style="letter-spacing: 2pt"> </span>serve<span style="letter-spacing: 2pt"> </span>as<span style="letter-spacing: 2pt"> </span>an<span style="letter-spacing: 2pt"> </span>instruction<span style="letter-spacing: 2pt">
</span>to<span style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt"> </span>Settlement<span style="letter-spacing: 2pt"> </span>Administrator<span style="letter-spacing: 2pt"> </span>to<span
style="letter-spacing: 2pt"> </span>make payments<span style="letter-spacing: 2pt"> </span>in<span style="letter-spacing: 2pt"> </span>that fashion. However, in the event the Settlement Administrator pays SARG for the full amount of
Client’s settlement and the payment is in the form of a check in Client’s name, Client gives SARG<span style="letter-spacing: 2pt"> </span>power<span style="letter-spacing: 2pt"> </span>of<span style="letter-spacing: 2pt">
</span>attorney<span style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt"> </span>endorse<span style="letter-spacing: 2pt"> </span>Client’s<span style="letter-spacing: 2pt"> </span>name<span
style="letter-spacing: 2pt"> </span>on<span style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt"> </span>check<span style="letter-spacing: 2pt"> </span>and<span style="letter-spacing: 2pt"> </span>authorizes SARG
to deposit<span style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt"> </span>check<span style="letter-spacing: 2pt"> </span>in a Trust or Escrow Account, for SARG to<span style="letter-spacing: 2pt">
</span>retain<span style="letter-spacing: 2pt"> </span>its<span style="letter-spacing: 2pt"> </span>fees,<span style="letter-spacing: 2pt"> </span>and<span style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt">
</span>issue Client’s payment to Client. In the event a check or electronic payment for the full amount of the settlement is sent directly to Client from<span style="letter-spacing: -0.15pt"> </span>the Settlement Administrator,
Client agrees to within 3 days deliver to SARG<span style="letter-spacing: -0.7pt"> </span>its full agreed upon fee by check or<span style="letter-spacing: 2pt"> </span>wire transfer.<br></div>
<div><br></div>
<div><span style="">6.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Obligation<span style="letter-spacing: -0.2pt"> </span>for Payment of SARG's Fees if Client Terminates</u></b>. Client shall have three days from the date this Agreement is signed to
terminate the Agreement. Client will owe SARG nothing if termination is timely made. Cancellation must be made by email to
<u><span class="font" style="font-family: "Times New Roman", serif"><a target="_blank" rel="noopener noreferrer" href="mailto:claims@sargrp.com">claims@sargrp.com</a></span></u><span class="font"
style="font-family: "Times New Roman", serif"> </span>Following three days, Client shall be bound by the terms of the Agreement, including its commitment regarding payment of SARG's fees.<br></div>
</div>
<div class="WordSection2">
<p style="margin-top: 0px" class="MsoBodyText"><span class="size" style="font-size: 9.5pt"> </span><br></p>
<p style="margin-right: 7.95pt; line-height: 95%; margin-top: 0px" class="MsoListParagraph"><span style="">7.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Limited Representation & Tax Advice Excluded</u>. </b>SARG<b style=""> </b>is only representing Client for<span style="letter-spacing: -0.15pt"> </span>eligibility<span
style="letter-spacing: -0.15pt"> </span>confirmation<span style="letter-spacing: -0.15pt"> </span>and<span style="letter-spacing: -0.15pt"> </span>Claim<span style="letter-spacing: -0.15pt"> </span>submission<span
style="letter-spacing: -0.15pt"> </span>and<span style="letter-spacing: -0.15pt"> </span>for<span style="letter-spacing: -0.15pt"> </span>no<span style="letter-spacing: -0.15pt"> </span>other<span style="letter-spacing: -0.15pt">
</span>purpose.<span style="letter-spacing: -0.15pt"> </span>SARG’s<span style="letter-spacing: -0.15pt"> </span>representation<span style="letter-spacing: -0.15pt"> </span>does not<span style="letter-spacing: -0.1pt">
</span>include<span style="letter-spacing: -0.1pt"> </span>any<span style="letter-spacing: -0.1pt"> </span>tax-<span style="letter-spacing: -0.05pt"> </span>related<span style="letter-spacing: -0.05pt"> </span>advice,<span
style="letter-spacing: -0.05pt"> </span>including,<span style="letter-spacing: -0.05pt"> </span>advice<span style="letter-spacing: -0.1pt"> </span>relating<span style="letter-spacing: -0.05pt"> </span>to<span
style="letter-spacing: -0.05pt"> </span>the<span style="letter-spacing: -0.05pt"> </span>effect<span style="letter-spacing: -0.05pt"> </span>of<span style="letter-spacing: -0.1pt"> </span>submitting<span
style="letter-spacing: -0.05pt"> </span>the<span style="letter-spacing: -0.05pt"> </span>Claim<span style="letter-spacing: -0.1pt"> </span>in<span style="letter-spacing: -0.05pt"> </span>the Action<span style="letter-spacing: 2pt">
</span>or<span style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt"> </span>taxable consequences of receiving payment from the settlement.<br></p>
<div><br></div>
<p style="margin-top: 0px" class="MsoBodyText"><span style="">8.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Association<span style="letter-spacing: -0.4pt"> </span>of Additional Counsel</u>.<span style="letter-spacing: -0.4pt"> </span></b>SARG shall have<span style="letter-spacing: 2pt">
</span>the option to associate<span style="letter-spacing: 2pt"> </span>with lawyers<span style="letter-spacing: -0.2pt"> </span>or law firms. Client will<span style="letter-spacing: -0.4pt"> </span>not have to pay<span
style="letter-spacing: -0.2pt"> </span>any<span style="letter-spacing: -0.1pt"> </span>additional<span style="letter-spacing: -0.15pt"> </span>fees.<br></p>
<div><br></div>
<p style="margin-top: 0px" class="MsoBodyText"><span style="">9.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Duties of Client</u>.<span style="letter-spacing: 2pt"> </span></b>Client agrees to cooperate fully with SARG during the course of representation to advise SARG fully of all pertinent
matters, and<span style="letter-spacing: 2pt"> </span>to provide truthful and accurate information to the best of Client’s knowledge. Client agrees to keep SARG informed of Client’s current mailing address, email<span
style="letter-spacing: -0.55pt"> </span>address, and telephone number, and in the event any of them change, to email SARG with the new contact information. SARG and Client both agree to be available,<span
style="letter-spacing: 2pt"> </span>upon reasonable request of the other, for telephone calls or email conversations to discuss the settlement, Claim process, or the representation.<br></p>
<div><br></div>
<p style="margin-top: 0px" class="MsoBodyText"><span class="size" style="font-size: 10.5pt">1</span><span style="">0.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Client’s Representations and Acknowledgments</u>. </b>Client acknowledges it has not submitted a Claim on its own behalf nor has Client retained any other representative or a lawyer,
law firm, or third party to submit a Claim on its behalf. Client acknowledges it will not submit its own Claim in the future unless this Agreement is terminated pursuant to its terms. Client acknowledges it will not sign an agreement
with any other representatives, lawyer, law firm, or third party in the future unless this Agreement is terminated pursuant to its terms. In the event SARG learns Client has submitted its own<span style="letter-spacing: 1.6pt">
</span>Claim,<span style="letter-spacing: 1.6pt"> </span>or<span style="letter-spacing: 1.6pt"> </span>there<span style="letter-spacing: 1.6pt"> </span>is<span style="letter-spacing: 1.6pt"> </span>a<span
style="letter-spacing: 1.6pt"> </span>duplicative representation<span style="letter-spacing: 1.85pt"> </span>of<span style="letter-spacing: 1.8pt"> </span>Client<span style="letter-spacing: 1.8pt"> </span>by<span
style="letter-spacing: 1.8pt"> </span>another representative,<span style="letter-spacing: 1.8pt"> </span>lawyer,<span style="letter-spacing: 1.8pt"> </span>law firm<span style="letter-spacing: 2pt"> </span>or<span
style="letter-spacing: 2pt"> </span>third<span style="letter-spacing: 2pt"> </span>party,<span style="letter-spacing: 2pt"> </span>Client<span style="letter-spacing: 2pt"> </span>agrees<span style="letter-spacing: 2pt">
</span>this<span style="letter-spacing: 2pt"> </span>Agreement<span style="letter-spacing: 2pt"> </span>with<span style="letter-spacing: 2pt"> </span>SARG<span style="letter-spacing: 2pt"> </span>shall<span
style="letter-spacing: 2pt"> </span>supersedes<span style="letter-spacing: 2pt"> </span>Client’s<span style="letter-spacing: 2pt"> </span>own submission or any other agreement entered into with any other representative, lawyer,<span
style="letter-spacing: 2pt"> </span>law<span style="letter-spacing: 2pt"> </span>firm,<span style="letter-spacing: 2pt"> </span>or third party, regardless of when the submission was made or agreement entered. Client authorizes SARG
to use this Agreement as evidence that it intends on SARG and only SARG to handle its Claim. Client represents that its interest in the Action, including its right to the<span style="letter-spacing: -0.2pt"> </span>proceeds of<span
style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt"> </span>Claim, have<span style="letter-spacing: 2pt"> </span>not<span style="letter-spacing: 1.65pt"> </span>been<span style="letter-spacing: 1.95pt">
</span>sold,<span style="letter-spacing: 1.5pt"> </span>assigned,<span style="letter-spacing: 1.65pt"> </span>or<span style="letter-spacing: 2pt"> </span>conveyed<span style="letter-spacing: 1.75pt"> </span>to<span
style="letter-spacing: 1.95pt"> </span>any<span style="letter-spacing: 1.65pt"> </span>other person<span style="letter-spacing: 1.95pt"> </span>or entity,<span style="letter-spacing: 1.8pt"> </span>and<span
style="letter-spacing: 2pt"> </span>that<span style="letter-spacing: 2pt"> </span>the individual signing this Agreement for Client has the authority to execute and bind Client to the obligations hereunder. Likewise, in the event the
Client is a<span style="letter-spacing: 2pt"> </span>dissolved entity, the individual signing this agreement for Client acknowledges the signor is the rightful and lawful successor in interest to the entity entitled to receive the
payment under the settlement and that no other party has claimed<span style="letter-spacing: 2pt"> </span>or is claiming entitlement to some or all of the payment. Client also represents that is not a debtor in any current bankruptcy
nor is<span style="letter-spacing: 2pt"> </span>it a party to any franchise agreement. Client acknowledges SARG is providing value in this matter by using their experience and knowledge to ensure Client’s Claim is properly submitted
at<span style="letter-spacing: 2pt"> </span>an early stage and to ensure that Client’s Claim is filed correctly and timely. Client has access to ask SARG<span style="letter-spacing: 2pt"> </span>any questions about its representation
of Client and to supplement the Claim with additional documentation<span style="letter-spacing: -0.1pt"> </span>and<span style="letter-spacing: -0.1pt"> </span>information<span style="letter-spacing: -0.1pt"> </span>in<span
style="letter-spacing: -0.1pt"> </span>the<span style="letter-spacing: -0.1pt"> </span>event<span style="letter-spacing: -0.1pt"> </span>Client<span style="letter-spacing: -0.15pt"> </span>or<span style="letter-spacing: -0.15pt">
</span>SARG<span style="letter-spacing: -0.1pt"> </span>dispute<span style="letter-spacing: -0.1pt"> </span>the<span style="letter-spacing: -0.1pt"> </span>amount<span style="letter-spacing: -0.1pt"> </span>of<span
style="letter-spacing: -0.15pt"> </span>the<span style="letter-spacing: -0.15pt"> </span>settlement<span style="letter-spacing: 1.15pt"> </span>offer, and<span style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt">
</span>otherwise<span style="letter-spacing: 2pt"> </span>have<span style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt"> </span>questions<span style="letter-spacing: 2pt"> </span>answered<span
style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt"> </span>best<span style="letter-spacing: 2pt"> </span>of SARG's ability.<span style="letter-spacing: 2pt">
</span>Further, Client is aware that by working with SARG it is certain to have its Claim submitted when typically, in claims- made<span style="letter-spacing: 2pt"> </span>settlements in class actions, on average only 2-7% of
class<span style="letter-spacing: 1.95pt"> </span>members submit claims. This is an important factor in retaining SARG – even if Client could submit the<span style="letter-spacing: 2pt"> </span>Claim without having to pay a fee to
anyone - as it is possible Client would have ignored the Claim<span style="letter-spacing: -0.6pt"> </span>form when it is eventually sent by the Settlement Administrator.<br></p>
</div>
<p style="margin-top: 0px" class="MsoBodyText"><br></p>
<div><span style="">11.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Sworn Statement.</u> </b>To support the Claim, Client may be required to sign a sworn statement<span style="letter-spacing: -0.05pt"> </span>under<span style="letter-spacing: -0.05pt">
</span>penalty<span style="letter-spacing: -0.05pt"> </span>of<span style="letter-spacing: 2pt"> </span>perjury.<span style="letter-spacing: -0.05pt"> </span>Client<span style="letter-spacing: -0.05pt"> </span>authorizes<span
style="letter-spacing: -0.05pt"> </span>SARG<span style="letter-spacing: -0.05pt"> </span>to<span style="letter-spacing: -0.05pt"> </span>make<span style="letter-spacing: -0.1pt"> </span>that<span style="letter-spacing: -0.05pt">
</span>sworn<span style="letter-spacing: -0.1pt"> </span>statement<span style="letter-spacing: -0.05pt"> </span>and<span style="letter-spacing: -0.1pt"> </span>sign<span style="letter-spacing: -0.1pt"> </span>on its behalf. By signing
this Agreement, the individual signing for Client is signing under the penalties of perjury that the information submitted to SARG in connection with its eligibility for Claim submission is true and accurate, including that the signor
has the full authority to sign for Client, the company took Visa<span style="letter-spacing: -0.7pt"> </span>and<span style="letter-spacing: -0.7pt"> </span>Mastercard<span style="letter-spacing: -0.65pt"> </span>as<span
style="letter-spacing: -0.7pt"> </span>a<span style="letter-spacing: -0.7pt"> </span>form<span style="letter-spacing: -0.7pt"> </span>of<span style="letter-spacing: -0.7pt"> </span>payment<span style="letter-spacing: -0.7pt">
</span>between<span style="letter-spacing: -0.65pt"> </span>2004<span style="letter-spacing: -0.7pt"> </span>and<span style="letter-spacing: -0.7pt"> </span>2019,<span style="letter-spacing: -0.7pt"> </span>that<span
style="letter-spacing: -0.7pt"> </span>Client<span style="letter-spacing: -0.7pt"> </span>did<span style="letter-spacing: -0.7pt"> </span>not<span style="letter-spacing: -0.7pt"> </span>file<span style="letter-spacing: -0.7pt">
</span>for<span style="letter-spacing: -0.7pt"> </span>bankruptcy at any time, and that Client has not assigned its right to the proceeds from the settlement.<br></div>
<p style="margin-top: 0px" class="MsoBodyText"><br></p>
<div><span style="">12.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Confidentiality</u>. </b>The Parties agree to keep the terms of this Agreement confidential between each other, with the exception that the Parties may<span style="letter-spacing: 2pt">
</span>share the Agreement with the Settlement Administrator, Class Counsel, or the Court.<br></div>
<p style="margin-top: 0px" class="MsoBodyText"><br></p>
<div><span style="">13.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Total Agreement</u>.<span style="letter-spacing: 2pt"> </span></b>This Agreement represents the total agreement between Client and SARG regarding SARG's fees and expenses and other terms
involving representation of Client by SARG. Any modifications, additions, or other changes to this Agreement shall be made only in writing and signed by Client and SARG.<br></div>
<div><br></div>
<div><span style="">14.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Governing Law</u>.<span style="letter-spacing: 2pt"> </span></b>This Agreement shall be governed by the laws of the State of New York, without<span style="letter-spacing: 2pt">
</span>regard<span style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt"> </span>its<span style="letter-spacing: 2pt"> </span>conflict<span style="letter-spacing: 2pt"> </span>of<span style="letter-spacing: 2pt">
</span>laws<span style="letter-spacing: 2pt"> </span>and<span style="letter-spacing: 2pt"> </span>principles.<span style="letter-spacing: 2pt"> </span>If<span style="letter-spacing: 2pt"> </span>any<span style="letter-spacing: 2pt">
</span>term<span style="letter-spacing: 2pt"> </span>of<span style="letter-spacing: 2pt"> </span>this<span style="letter-spacing: 2pt"> </span>Agreement<span style="letter-spacing: 2pt"> </span>is<span style="letter-spacing: 2pt">
</span>held invalid<span style="letter-spacing: 1.95pt"> </span>or unenforceable,<span style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt"> </span>remainder<span style="letter-spacing: 2pt"> </span>of<span
style="letter-spacing: 2pt"> </span>the<span style="letter-spacing: 2pt"> </span>Agreement shall remain<span style="letter-spacing: 2pt"> </span>in<span style="letter-spacing: 2pt"> </span>effect.<br></div>
<div><br></div>
<div><span style="">15.<span class="font" style="font-family: "Times New Roman""><span class="size"
style="font-size: 7pt; font-style: normal; font-variant: normal; font-kerning: auto; font-feature-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal">
</span></span></span><b style=""><u style="">Dispute Resolution; Jury Trial Waiver</u>. </b>If Client and<span style="letter-spacing: 2pt"> </span>SARG are unable to amicably<span style="letter-spacing: 2pt"> </span>resolve
in good faith any dispute between them arising out of, or in connection with, this Agreement, the dispute<span style="letter-spacing: 2pt"> </span>must<span style="letter-spacing: 2pt"> </span>be<span style="letter-spacing: 2pt">
</span>submitted<span style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 4pt"> </span>arbitration<span style="letter-spacing: 2pt"> </span>before AAA (American Arbitration Association)<span
style="letter-spacing: 1.65pt"> </span>for resolution.<span style="letter-spacing: 2pt"> </span>The<span style="letter-spacing: 2pt"> </span>arbitration<span style="letter-spacing: 2pt"> </span>shall<span
style="letter-spacing: 2pt"> </span>be<span style="letter-spacing: 2pt"> </span>administered<span style="letter-spacing: 2pt"> </span>by<span style="letter-spacing: 2pt"> </span>a<span style="letter-spacing: 2pt"> </span>single AAA
arbitrator<span style="letter-spacing: 2pt"> </span>pursuant<span style="letter-spacing: 2pt"> </span>to<span style="letter-spacing: 2pt"> </span>their<span style="letter-spacing: 4pt"> </span>Comprehensive Arbitration Rules &
Procedures, under which Client and SARG shall share equally in the costs of the arbitration. Judgment on any arbitral award may be entered in any court of competent jurisdiction. This clause shall not preclude parties from seeking
provisional remedies in aid of arbitration from<span style="letter-spacing: 2pt"> </span>a<span style="letter-spacing: 3.35pt"> </span>court<span style="letter-spacing: 3.35pt"> </span>of<span style="letter-spacing: 3.35pt">
</span>appropriate<span style="letter-spacing: 3.4pt"> </span>jurisdiction.<span style="letter-spacing: 3.35pt"> </span>Client<span style="letter-spacing: 3.1pt"> </span>and SARG agree<span style="letter-spacing: 3.4pt"> </span>that New
York law<span style="letter-spacing: 3.4pt"> </span>applies in<span style="letter-spacing: 2pt"> </span>the determination and adjudication of the parties’ rights, responsibilities, and obligations in any such dispute. Client<span
style="letter-spacing: 3.95pt"> </span>may<span style="letter-spacing: 3.95pt"> </span>consult<span style="letter-spacing: 3.95pt"> </span>an attorney<span style="letter-spacing: 3.95pt"> </span>to<span style="letter-spacing: 3.95pt">
</span>evaluate<span style="letter-spacing: 4pt"> </span>this<span style="letter-spacing: 3.95pt"> </span>arbitration<span style="letter-spacing: 4pt"> </span>requirement.<span style="letter-spacing: 3.95pt"> </span>By<span
style="letter-spacing: 3.75pt"> </span>entering<span style="letter-spacing: 2pt"> </span>into an agreement that requires arbitration as the way to resolve certain disputes, Client waives the right to go to court to resolve those
disputes by a<span style="letter-spacing: -0.35pt"> </span>judge or jury.<br></div>
<p style="margin-top: 0px" class="MsoBodyText"><span class="size" style="font-size: 9.5pt"> </span><br></p>
<p style="margin-left: 5.05pt; margin-top: 0px" class="MsoBodyText">THE<span style="letter-spacing: -1.85pt"> </span>PARTIES<span style="letter-spacing: -0.4pt"> </span>HERETO<span style="letter-spacing: -1pt"> </span>AGREE<span
style="letter-spacing: 0.05pt"> </span>TO<span style="letter-spacing: -1.1pt"> </span>BE<span style="letter-spacing: -0.25pt"> </span>BOUND<span style="letter-spacing: 0.2pt"> </span>BY<span style="letter-spacing: -0.25pt">
</span>THE<span style="letter-spacing: -1.65pt"> </span>AGREEMENT<span style="letter-spacing: -0.5pt"> </span>AS<span style="letter-spacing: 0.05pt"> </span>OF<span style="letter-spacing: -0.3pt"> </span>THE<span
style="letter-spacing: -1.65pt"> </span>DATE<span style="letter-spacing: -0.1pt"> BELOW.</span><br></p>
<div><br></div>
<div><b>SERENDIPITY ASSET RECOVERY GROUP</b><br></div>
<div><br></div>
<div><b><img src="/api/downloadimagedesc?filepath=%2Fh7p9dFuZ63kYkkwB1x3YFFpoCDRpsgBSZQkdW5lpwm0%2Fzeimage%2F1714769577345_joshSign.jpg&zaaidenc=a7aa12cc39aca361496a6669146e56b9" width="282" height="74" style=""><br></b></div>
<div><br></div>
<div><br></div>
<div><b>CLIENT</b><br></div>
<div><br></div>
<div><b>Printed Name:</b> <u><span elname="setlabel_Name_First" style="">___</span> <span elname="setlabel_Name_Last" style="">___</span></u> <br></div>
<div><br></div>
<div><b>Title:</b> <u><span elname="setlabel_Dropdown1" style="">___</span></u><br></div>
</label>
<div class="clearBoth"></div>
</li>
<li tabindex="-1" class="sign tempFrmWrapper large" elname="livefield-elem" comptype="25" id="Signature-li" needdata="true" compname="Signature" linkname="Signature" isvisible="true" mandatory="true" page_no="3" page_link_name="Page2"
counteruid="35">
<label id="Signature-arialabel" class="labelName"><span>Signature</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv">
<div class="signContainer" elname="signContainer" id="signContainer-Signature"><span class="sr-only" elname="eSignatureSpan" id="Signature-esign">E-Signature Field</span>
<canvas aria-describedby="hint-Signature" aria-labelledby="Signature-arialabel Signature-esign" tabindex="0" id="drawingCanvas-Signature" signaturefieldparent="form" width="0"></canvas>
<div class="signArea" elname="signArea" id="sign-area-Signature" style="display:none;height:70px"></div>
<a id="clearSign" role="button" elname="clearSign" class="instrSpace" href="javascript:void(0);" onclick="clearSignature('drawingCanvas-Signature');">Clear</a>
</div>
<p class="errorMessage" elname="error" id="error-Signature"></p>
</div>
<div class="clearBoth"></div>
<script type="module">
setCanvasElemWidth("Signature"); //No I18N
$("#drawingCanvas-Signature").mousedown(function(event) {
var canvasElem = document.getElementById("drawingCanvas-Signature"); //No I18N
var signatureFieldParent = $(canvasElem).attr('signaturefieldparent'); //No I18N
var fontColor = "#000000";
var inputElem = ""; //No I18N
if (signatureFieldParent == "subform") {
inputElem = $("#formBodyDiv").find(".formFieldWrapper li[elemType=subFormField][viewtype=1] input[type=text]:first"); //No I18N
if (inputElem.length == 0) { //No I18N
inputElem = $("#formBodyDiv").find(".formFieldWrapper li[elemType=subFormField][viewtype=1] textarea:first"); //No I18N
}
} else { //No I18N
inputElem = $("#formBodyDiv").find(".formFieldWrapper > .tempFrmWrapper > .tempContDiv input[type=text]:first"); //No I18N
if (inputElem.length == 0) { //No I18N
inputElem = $("#formBodyDiv").find(".formFieldWrapper > .tempFrmWrapper > .tempContDiv textarea:first"); //No I18N
}
}
if (inputElem != "" && inputElem.length > 0) {
fontColor = inputElem.css("color"); // No I18N
}
var context = canvasElem.getContext("2d"); // No I18N
var position = getXYCoords(event, canvasElem, false);
context.moveTo(position.X, position.Y);
context.beginPath();
$(this).mousemove(function(event) {
startScribbling(event, canvasElem, context, false, fontColor);
}).mouseup(function(event) {
endScribbling(event, canvasElem, context, fontColor);
var fieldElem = getClosestFieldElemLi(canvasElem); // No I18N
removeErrorFromLiElem(fieldElem); // No I18N
}).mouseout(function(event) {
endScribbling(event, canvasElem, context, fontColor);
var fieldElem = getClosestFieldElemLi(canvasElem); // No I18N
removeErrorFromLiElem(fieldElem); // No I18N
});
this.addEventListener('touchstart', function(event) {
position = getXYCoords(event, canvasElem, true);
context.moveTo(position.X, position.Y);
context.beginPath();
event.preventDefault();
}, false);
this.addEventListener('touchmove', function(event) {
startScribbling(event, canvasElem, context, true, fontColor);
event.preventDefault();
}, false);
});
var userAgent = window.navigator.userAgent;
var msie = userAgent.indexOf("MSIE ");
if (msie > 0) {
$("#drawingCanvas-Signature").keypress(function(event) {
if (event.keyCode === 13) {
event.preventDefault();
}
});
}
if (false == true) //No I18N
{
$("#drawingCanvas-Signature").css("pointer-events", "none"); //No I18N
$("#drawingCanvas-Signature").css("cursor", "default"); //No I18N
}
</script>
</li>
<li tabindex="-1" isunique="false" class="tempFrmWrapper date fieldDisabled" elname="livefield-elem" comptype="5" id="Date-li" compname="Date" linkname="Date" needdata="true" isvisible="true" disableddays="{}" startoftheweek="0"
mandatory="true" page_no="3" page_link_name="Page2" showlabel="true" counteruid="36">
<label class="labelName" for="Date-date">
<span>Date</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" datelocale="en-GB" elname="mm/dd/yy" id="DatedateDiv" isdisable="true" elemname="fieldContentDiv">
<span>
<div class="calendarCont" elname="calendarContDiv">
<input aria-describedby="hint-Date Date-subInfoText" aria-haspopup="dialog" tabindex="0" name="Date" elname="date" id="Date-date" onchange="ZFLive.validateFieldConstraint(this);"
onkeyup="ZFLive.handleKeyNavigationsForDatePicker(this, event, false);" onfocusout="checkDatePicker(this);" autocomplete="off" onclick="ZFUtil.showLiveDatePicker(this)" onfocus="ZFUtil.showLiveDatePicker(this)" type="text"
value="08/22/2024" disabled="" placeholder="" class="hasDatepicker">
<div class="calIconWrapper" role="img" aria-label="Date" elname="imgWrapDiv"><img class="calendarIcon" src="https://static.zohocdn.com/forms/images/spacer.325472601571f31e1bf00674c368d335.gif" title="..."
style="opacity: 0.5; cursor: default;"></div>
<span class="sr-only" elname="arialabel-month" id="Date-month">Month</span>
<span class="sr-only" elname="arialabel-year" id="Date-year">Year</span>
<div class="clearBoth"></div>
</div><label class="formSubInfoText" elname="formSubInfoText" id="Date-subInfoText">MM/dd/yyyy</label>
</span>
<p class="errorMessage" elname="error" id="error-Date"></p>
<span style="display:none">
<script type="module">
$(function() {
var dateformat = $("#DatedateDiv").attr("elname"); // No I18N
var actualDateFormat = "MM/dd/yyyy"; // No I18N
var dateLocale = $("#DatedateDiv").attr("datelocale"); // No I18N
var weekStart = "0"; // No I18N
if (typeof weekStart == ResponseKey.UNDEFINED || weekStart == "") {
weekStart = 0;
}
if (typeof dateLocale == ResponseKey.UNDEFINED || dateLocale == "") {
dateLocale = "en-GB"; // No I18N
}
var disableDays = {};
$("#Date-date").datepicker({
showOn: "button", // No I18N
buttonImage: "https://static.zohocdn.com/forms/images/spacer.325472601571f31e1bf00674c368d335.gif", // No I18N
buttonImageOnly: true,
dateFormat: dateformat,
showAnim: "drop", // No I18N
changeMonth: true,
yearRange: "1900:2100",
firstDay: weekStart,
beforeShowDay: function(date) {
return ZFUtil.blockDisabledDaysAndHolidays(date, disableDays);
},
beforeShow: function() {
ZFUtil.setDateLimit(this, actualDateFormat, dateLocale);
},
onClose: function() {
$(this).focus();
},
onChangeMonthYear: function(year, month, inst) {
setTimeout(function() {
ZFLive.handleKeyNavigationsForDatePicker(this, event, true);
}, 0);
},
monthNamesShort: CustomDateLocale[dateLocale].monthNamesShort,
monthNames: CustomDateLocale[dateLocale].monthNames,
dayNamesMin: CustomDateLocale[dateLocale].dayNamesMin,
showMonthAfterYear: CustomDateLocale[dateLocale].showMonthAfterYear,
yearSuffix: CustomDateLocale[dateLocale].yearSuffix,
changeYear: true
});
var dateDiv = $("#DatedateDiv"); // No I18N
var imgElem = $(dateDiv).find('img'); // No I18N
$(imgElem).removeClass("ui-datepicker-trigger"); // No I18N
$(imgElem).addClass("calendarIcon"); // No I18N
$(imgElem).mousedown(function(e) {
e.preventDefault();
});
//$(imgElem).attr("title",""); // Hovering on date picker icon displays the Date field's label
$(imgElem).removeAttr("alt"); // No I18N
/*
When spacing is applied for input fields in Themes, calendar icon needs to vertical aligned with input.
For that img element should be placed inside a div.
*/
var imgWrapDiv = $('<div class="calIconWrapper" role="img" aria-label="Date" elname="imgWrapDiv"></div>');
$(imgWrapDiv).insertBefore(imgElem);
$(imgElem).appendTo(imgWrapDiv);
//The below class add to set z-index
$('#ui-datepicker-div').addClass("calIndex");
$('#ui-datepicker-div').addClass("notranslate");
if (true == true) {
$("#Date-date").datepicker().datepicker('disable'); //No I18N
}
});
//$("#DatedateDiv").find('img').addClass("calendarIcon");
</script>
</span>
</div>
</li>
<li isunique="false" class="tempFrmWrapper time fieldDisabled zfSelect2CustomCont" elname="livefield-elem" comptype="6" id="Time-li" needdata="true" compname="Time" linkname="Time" isvisible="true" timeformat="1" mandatory="false" page_no="3"
page_link_name="Page2" counteruid="57">
<label id="Time-arialabel" class="labelName"><span>Time</span>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv">
<div>
<span elname="compEachElem">
<div class="inputDisabled form_selectBox">
<div class="selectArrow"></div><select aria-labelledby="Time-arialabel Time-arialabel-hours" aria-describedby="hint-Time" timecomp="hours" name="Time" onchange="ZFLive.prefillFieldLabel(this);ZFLive.checkUniqueTimeFld(this);"
disabled="" tabindex="-1" class="select2-hidden-accessible" aria-hidden="true">
<option value=""></option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05" selected="true">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
</select><span class="select2 select2-container select2-container--default select2-container--disabled" dir="ltr" style="width: auto;"><span class="selection"><span class="select2-selection select2-selection--single select2FormCont"
role="listbox" aria-haspopup="true" aria-expanded="false" tabindex="-1" aria-labelledby="select2-Time-s9-container Time-arialabel Time-arialabel-hours "><span class="select2-selection__rendered" id="select2-Time-s9-container"
title="05" role="option">
<div class="select2FormFont">05</div>
</span><span class="select2-selection__arrow select2FormArrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</div><label class="formSubInfoText formSubInfoAlign" elname="formSubInfoText" id="Time-arialabel-hours">HH</label>
</span><span class="symbols" aria-hidden="true">:</span> <span elname="compEachElem">
<div class="inputDisabled form_selectBox">
<div class="selectArrow"></div><select aria-labelledby="Time-arialabel Time-arialabel-minutes" aria-describedby="hint-Time" timecomp="minutes" name="Time" onchange="ZFLive.prefillFieldLabel(this);ZFLive.checkUniqueTimeFld(this);"
disabled="" tabindex="-1" class="select2-hidden-accessible" aria-hidden="true">
<option value=""></option>
<option value="00">00</option>
<option value="01">01</option>
<option value="02">02</option>
<option value="03">03</option>
<option value="04">04</option>
<option value="05">05</option>
<option value="06">06</option>
<option value="07">07</option>
<option value="08">08</option>
<option value="09">09</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
<option value="32">32</option>
<option value="33">33</option>
<option value="34">34</option>
<option value="35">35</option>
<option value="36">36</option>
<option value="37">37</option>
<option value="38">38</option>
<option value="39">39</option>
<option value="40">40</option>
<option value="41">41</option>
<option value="42">42</option>
<option value="43">43</option>
<option value="44">44</option>
<option value="45">45</option>
<option value="46">46</option>
<option value="47">47</option>
<option value="48">48</option>
<option value="49">49</option>
<option value="50">50</option>
<option value="51">51</option>
<option value="52">52</option>
<option value="53">53</option>
<option value="54">54</option>
<option value="55">55</option>
<option value="56">56</option>
<option value="57">57</option>
<option value="58" selected="true">58</option>
<option value="59">59</option>
</select><span class="select2 select2-container select2-container--default select2-container--disabled" dir="ltr" style="width: auto;"><span class="selection"><span class="select2-selection select2-selection--single select2FormCont"
role="listbox" aria-haspopup="true" aria-expanded="false" tabindex="-1" aria-labelledby="select2-Time-kp-container Time-arialabel Time-arialabel-minutes "><span class="select2-selection__rendered"
id="select2-Time-kp-container" title="58" role="option">
<div class="select2FormFont">58</div>
</span><span class="select2-selection__arrow select2FormArrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</div><label class="formSubInfoText formSubInfoAlign" elname="formSubInfoText" id="Time-arialabel-minutes">MM</label>
</span>
<span class="symbols" aria-hidden="true">:</span> <!--span>
<input type="text" maxlength="2" size="2" name="seconds" /><label elname="formSubInfoText" class="formSubInfoText formSubInfoAlign" id="Time-arialabel-seconds">SS</label>
</span-->
<span elname="compEachElem">
<div class="inputDisabled form_selectBox">
<div class="selectArrow"></div><select aria-labelledby="Time-arialabel Time-arialabel-meridiem" aria-describedby="hint-Time" timecomp="Meridiem" name="Time" data-minimum-results-for-search="Infinity"
onchange="ZFLive.prefillFieldLabel(this);ZFLive.checkUniqueTimeFld(this);" disabled="" tabindex="-1" class="select2-hidden-accessible" aria-hidden="true">
<option value=""></option>
<option value="AM" selected="true">AM</option>
<option value="PM">PM</option>
</select><span class="select2 select2-container select2-container--default select2-container--disabled" dir="ltr" style="width: auto;"><span class="selection"><span class="select2-selection select2-selection--single select2FormCont"
role="listbox" aria-haspopup="true" aria-expanded="false" tabindex="-1" aria-labelledby="select2-Time-qc-container Time-arialabel Time-arialabel-meridiem "><span class="select2-selection__rendered"
id="select2-Time-qc-container" title="AM" role="option">
<div class="select2FormFont">AM</div>
</span><span class="select2-selection__arrow select2FormArrow" role="presentation"><b role="presentation"></b></span></span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span>
</div><label class="formSubInfoText formSubInfoAlign" elname="formSubInfoText" id="Time-arialabel-meridiem">AM / PM</label>
</span>
<div class="clearBoth"></div>
</div>
<p class="errorMessage" elname="error" id="error-Time"></p>
</div>
<div class="clearBoth"></div>
</li>
</ul>
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<h2>AUTHORITY TO REPRESENT</h2>
<p></p>
</li>
<!--To exclude Html field in rules we are setting comptype as 0 for Html field. That is Html field will not be included in any condition. -->
<li tabindex="0" id="HtmlText1-li" class="tempFrmWrapper note" elem_type_int="5" elname="livefield-elem" compname="HtmlText1" comptype="0" page_no="4" page_link_name="Page3" counteruid="38">
<label class="descFld" elname="descFldLabel" tabindex="0">
<div class="WordSection1">
<p style="margin: 0px; text-indent: 0.5in; line-height: 151%"><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt; line-height: 151%">On behalf of <span
elname="setlabel_SingleLine" style="">___</span> (Legal<span style="letter-spacing: -0.4pt"> </span>Name<span style="letter-spacing: -0.45pt"> </span>of<span style="letter-spacing: -0.55pt"> </span>Company)<span
style="letter-spacing: -0.4pt"> </span>(“Client”), <span style="letter-spacing: -0.3pt">I, <span elname="setlabel_Name_First" style="">___</span> <span elname="setlabel_Name_Last" style="">___</span></span>,
(Authorized Signor for Client), hereby authorize Serendipity<span style="letter-spacing: -0.1pt"> </span>Asset Recovery Group, LLC. (hereinafter “SARG”) and its members and/or employees<span style="letter-spacing: -0.3pt">
</span>and<span style="letter-spacing: -0.15pt"> </span>agents<span style="letter-spacing: -0.25pt"> </span>(collectively<span style="letter-spacing: -0.15pt"> </span>“SARG”),<span style="letter-spacing: -0.1pt"> </span>to<span
style="letter-spacing: -0.4pt"> </span>act<span style="letter-spacing: -0.15pt"> </span>as<span style="letter-spacing: -0.3pt"> </span>my<span style="letter-spacing: -0.15pt"> </span>exclusive<span style="letter-spacing: 2pt">
</span>representatives,<span style="letter-spacing: -0.1pt"> </span>and<span style="letter-spacing: -0.15pt"> </span>agents in connection with all<span style="letter-spacing: -0.1pt"> </span>my rights<span
style="letter-spacing: -0.05pt"> </span>as<span style="letter-spacing: -0.05pt"> </span>a class<span style="letter-spacing: -0.05pt"> </span>member<span style="letter-spacing: -0.05pt"> </span>entitled to<span
style="letter-spacing: -0.15pt"> </span>a settlement payment<span style="letter-spacing: -0.15pt"> </span>in the action styled: In re Payment Card Interchange Fee and Merchant Discount<span style="letter-spacing: -0.2pt">
</span>Antitrust Litigation, MDL No. 1720, currently pending in the United States District Court for the Eastern District of New York (“Action”).</span></span><br></p>
<div><br></div>
<p style="margin: 0px"><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt">SARG<span style="letter-spacing: -0.25pt"> </span>has<span style="letter-spacing: -0.25pt">
</span>Client’s<span style="letter-spacing: -0.2pt"> </span>full<span style="letter-spacing: -0.1pt"> </span>authority<span style="letter-spacing: -0.1pt"> </span>to<span style="letter-spacing: -0.3pt"> </span>work<span
style="letter-spacing: -0.1pt"> </span>with<span style="letter-spacing: -0.3pt"> </span>Epiq<span style="letter-spacing: -0.05pt"> </span>Class<span style="letter-spacing: -0.75pt"> </span>Action<span
style="letter-spacing: -0.1pt"> </span>&<span style="letter-spacing: -0.1pt"> </span>Claims<span style="letter-spacing: -0.15pt"> </span><span style="letter-spacing: -0.1pt">Solutions, </span>Inc.<span
style="letter-spacing: -0.4pt"> </span>(“Settlement<span style="letter-spacing: -0.75pt"> </span>Administrator”)<span style="letter-spacing: -0.3pt"> </span>for<span style="letter-spacing: -0.1pt"> </span>purposes<span
style="letter-spacing: -0.3pt"> </span>of<span style="letter-spacing: -0.1pt"> </span>determining<span style="letter-spacing: -0.2pt"> </span>Client’s<span style="letter-spacing: -0.3pt"> </span>eligibility<span
style="letter-spacing: -0.35pt"> </span><span style="letter-spacing: -0.25pt">for </span></span><span class="size" style="font-size: 12pt; line-height: 150%">participation as a class member in the<span
style="letter-spacing: -0.35pt"> </span>Action. If the event Client is eligible, Client hereby instructs<span style="letter-spacing: -0.25pt"> </span>the<span style="letter-spacing: -0.2pt"> </span>Settlement<span
style="letter-spacing: -0.75pt"> </span>Administrator<span style="letter-spacing: -0.3pt"> </span>to<span style="letter-spacing: -0.4pt"> </span>send<span style="letter-spacing: -0.15pt"> </span>Client’s<span
style="letter-spacing: -0.3pt"> </span>claim<span style="letter-spacing: -0.15pt"> </span>form<span style="letter-spacing: -0.15pt"> </span>directly<span style="letter-spacing: -0.15pt"> </span>to SARG<span
style="letter-spacing: -0.15pt"> </span>(without<span style="letter-spacing: -0.35pt"> </span>a copy to Client), as SARG will submit the required claim and/or supporting or supplemental information<span
style="letter-spacing: -0.2pt"> </span>on<span style="letter-spacing: -0.45pt"> </span>Client’s<span style="letter-spacing: -0.35pt"> </span>behalf.<span style="letter-spacing: -0.15pt"> </span>If<span
style="letter-spacing: -0.2pt"> </span>Client’s<span style="letter-spacing: -0.35pt"> </span>signature<span style="letter-spacing: -0.25pt"> </span>is<span style="letter-spacing: -0.3pt"> </span>required<span
style="letter-spacing: -0.45pt"> </span>for<span style="letter-spacing: -0.35pt"> </span>the<span style="letter-spacing: -0.25pt"> </span>claim,<span style="letter-spacing: -0.05pt"> </span>SARG<span
style="letter-spacing: -0.2pt"> </span>has<span style="letter-spacing: -0.35pt"> </span>Client’s authority to sign on Client’s behalf. SARG is authorized to file Client’s claim and to communicate<span
style="letter-spacing: -0.45pt"> </span>with<span style="letter-spacing: -0.25pt"> </span>the<span style="letter-spacing: -0.3pt"> </span>Settlement<span style="letter-spacing: -0.75pt"> </span>Administrator,<span
style="letter-spacing: -0.2pt"> </span>Class<span style="letter-spacing: -0.4pt"> </span>Counsel,<span style="letter-spacing: -0.2pt"> </span>and<span style="letter-spacing: -0.25pt"> </span>the<span
style="letter-spacing: -0.3pt"> </span>Court<span style="letter-spacing: -0.25pt"> </span>on<span style="letter-spacing: -0.5pt"> </span>Client’s<span style="letter-spacing: -0.4pt"> </span>behalf, for the entirety of the claims
process. The Settlement<span style="letter-spacing: -0.25pt"> </span>Administrator shall share any information about Client’s claim with<span style="letter-spacing: -0.05pt"> </span>SARG or SARG’s representative as SARG requests.
SARG shall have Client’s full authority to accept, reject, or negotiate the amount of Client’s payment on Client’s behalf. SARG shall direct the Settlement<span style="letter-spacing: -0.25pt"> </span>Administrator as to where and
how to send Client’s share of the proceeds. SARG shall be paid 30% of the gross amount due Client for Client’s claim. Unless<span style="letter-spacing: -0.1pt"> </span>SARG<span style="letter-spacing: -0.05pt">
</span>instructs<span style="letter-spacing: -0.15pt"> </span>Settlement<span style="letter-spacing: -0.75pt"> </span>Administrator otherwise, SARG’s <span style="letter-spacing: -0.15pt">30</span>% share<span
style="letter-spacing: -0.1pt"> </span>of the payment<span style="letter-spacing: -0.1pt"> </span>shall<span style="letter-spacing: -0.05pt"> </span>be<span style="letter-spacing: -0.1pt"> </span>sent<span
style="letter-spacing: -0.05pt"> </span>directly<span style="letter-spacing: -0.25pt"> </span>by<span style="letter-spacing: -0.05pt"> </span>the<span style="letter-spacing: -0.3pt"> </span>Settlement<span
style="letter-spacing: -0.75pt"> </span>Administrator to SARG<span style="letter-spacing: -0.05pt"> </span>and<span style="letter-spacing: -0.05pt"> </span>Client’s<span style="letter-spacing: -0.1pt"> </span>70% share of the
payment shall be sent directly by the Settlement<span style="letter-spacing: -0.15pt"> </span>Administrator to Client.</span></span><br></p>
<div><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 18pt"> </span></span><br></div>
<p style="margin: 0px; line-height: 150%"><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt; line-height: 150%">Client acknowledges that SARG represents other clients in
connection with the submission of claims in<span style="letter-spacing: -0.05pt"> </span>this<span style="letter-spacing: -0.55pt"> </span>Action and SARG is authorized to submit my claim along with others at the same time. If the
Settlement<span style="letter-spacing: -0.2pt"> </span>Administrator receives a Claim from Client or any other representative, lawyer,<span style="letter-spacing: -0.05pt"> </span>law<span style="letter-spacing: -0.2pt">
</span>firm,<span style="letter-spacing: -0.15pt"> </span>or<span style="letter-spacing: -0.2pt"> </span>third-party<span style="letter-spacing: -0.3pt"> </span>purporting<span style="letter-spacing: -0.3pt"> </span>to<span
style="letter-spacing: -0.3pt"> </span>have<span style="letter-spacing: -0.1pt"> </span>authority<span style="letter-spacing: -0.3pt"> </span>to<span style="letter-spacing: -0.25pt"> </span>represent<span
style="letter-spacing: -0.05pt"> </span>Client, this<span style="letter-spacing: -0.75pt"> </span>Authority<span style="letter-spacing: -0.05pt"> </span>to <span style="letter-spacing: -0.1pt">Represent </span>shall<span
style="letter-spacing: -0.1pt"> </span>supersede<span style="letter-spacing: -0.15pt"> </span>all<span style="letter-spacing: -0.1pt"> </span>and<span style="letter-spacing: -0.1pt"> </span>the<span
style="letter-spacing: -0.15pt"> </span>Settlement<span style="letter-spacing: -0.75pt"> </span>Administrator<span style="letter-spacing: -0.05pt"> </span>is<span style="letter-spacing: -0.2pt"> </span>instructed<span
style="letter-spacing: -0.15pt"> </span>to<span style="letter-spacing: -0.3pt"> </span>ignore<span style="letter-spacing: -0.35pt"> </span>the<span style="letter-spacing: -0.15pt"> </span>others<span
style="letter-spacing: -0.4pt"> </span>and<span style="letter-spacing: -0.1pt"> </span>work only with SARG. This last instruction is to avoid inadvertent duplication or confusion.</span></span><br></p>
</div>
<div><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt; line-height: 150%"><br style="page-break-before: always"></span></span></div>
<p style="margin: 0px"><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt">CLIENT’S<span style="letter-spacing: -0.3pt"> </span>CONSENT<span
style="letter-spacing: -0.75pt"> </span>AND<span style="letter-spacing: -0.2pt"> </span>CLIENT<span style="letter-spacing: -0.45pt"> </span><span style="letter-spacing: -0.1pt">INFORMATION</span></span></span><br></p>
<div><br></div>
<p style="margin: 0px; text-align: justify; line-height: 165%"><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt; line-height: 165%">Legal Name of
Company: <u><span elname="setlabel_SingleLine" style="">___</span></u></span></span><br></p>
<div><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt; line-height: 165%">Client’s Tax ID No.
(EIN): <u><span elname="setlabel_SingleLine1" style="">___</span></u></span></span><br></div>
<div><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt; line-height: 165%">Title of
Signor: <u><span elname="setlabel_Dropdown1" style="">___</span></u></span></span><br></div>
<div><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt; line-height: 165%">Email<span style="letter-spacing: -0.25pt">
</span>Address: <u><span elname="setlabel_Email" style="">___</span></u></span></span><br></div>
<div><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt; line-height: 165%"><span
style="letter-spacing: -0.1pt">Address: <u><span elname="setlabel_Address_AddressLine1" style="">___</span> <span elname="setlabel_Address_City" style="">___</span>, <span elname="setlabel_Address_Region" style="">___</span> <span elname="setlabel_Address_ZipCode" style="">___</span></u></span></span></span><br>
</div>
<div><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt; line-height: 165%">Telephone
Number: <u><span elname="setlabel_PhoneNumber" style="">___</span></u></span></span><br></div>
</label>
<div class="clearBoth"></div>
</li>
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counteruid="39">
<label id="Signature1-arialabel" class="labelName"><span>Signature</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" elemname="fieldContentDiv">
<div class="signContainer" elname="signContainer" id="signContainer-Signature1"><span class="sr-only" elname="eSignatureSpan" id="Signature1-esign">E-Signature Field</span>
<canvas aria-describedby="hint-Signature1" aria-labelledby="Signature1-arialabel Signature1-esign" tabindex="0" id="drawingCanvas-Signature1" signaturefieldparent="form" width="0"></canvas>
<div class="signArea" elname="signArea" id="sign-area-Signature1" style="display:none;height:70px"></div>
<a id="clearSign" role="button" elname="clearSign" class="instrSpace" href="javascript:void(0);" onclick="clearSignature('drawingCanvas-Signature1');">Clear</a>
</div>
<p class="errorMessage" elname="error" id="error-Signature1"></p>
</div>
<div class="clearBoth"></div>
<script type="module">
setCanvasElemWidth("Signature1"); //No I18N
$("#drawingCanvas-Signature1").mousedown(function(event) {
var canvasElem = document.getElementById("drawingCanvas-Signature1"); //No I18N
var signatureFieldParent = $(canvasElem).attr('signaturefieldparent'); //No I18N
var fontColor = "#000000";
var inputElem = ""; //No I18N
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inputElem = $("#formBodyDiv").find(".formFieldWrapper li[elemType=subFormField][viewtype=1] input[type=text]:first"); //No I18N
if (inputElem.length == 0) { //No I18N
inputElem = $("#formBodyDiv").find(".formFieldWrapper li[elemType=subFormField][viewtype=1] textarea:first"); //No I18N
}
} else { //No I18N
inputElem = $("#formBodyDiv").find(".formFieldWrapper > .tempFrmWrapper > .tempContDiv input[type=text]:first"); //No I18N
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inputElem = $("#formBodyDiv").find(".formFieldWrapper > .tempFrmWrapper > .tempContDiv textarea:first"); //No I18N
}
}
if (inputElem != "" && inputElem.length > 0) {
fontColor = inputElem.css("color"); // No I18N
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var context = canvasElem.getContext("2d"); // No I18N
var position = getXYCoords(event, canvasElem, false);
context.moveTo(position.X, position.Y);
context.beginPath();
$(this).mousemove(function(event) {
startScribbling(event, canvasElem, context, false, fontColor);
}).mouseup(function(event) {
endScribbling(event, canvasElem, context, fontColor);
var fieldElem = getClosestFieldElemLi(canvasElem); // No I18N
removeErrorFromLiElem(fieldElem); // No I18N
}).mouseout(function(event) {
endScribbling(event, canvasElem, context, fontColor);
var fieldElem = getClosestFieldElemLi(canvasElem); // No I18N
removeErrorFromLiElem(fieldElem); // No I18N
});
this.addEventListener('touchstart', function(event) {
position = getXYCoords(event, canvasElem, true);
context.moveTo(position.X, position.Y);
context.beginPath();
event.preventDefault();
}, false);
this.addEventListener('touchmove', function(event) {
startScribbling(event, canvasElem, context, true, fontColor);
event.preventDefault();
}, false);
});
var userAgent = window.navigator.userAgent;
var msie = userAgent.indexOf("MSIE ");
if (msie > 0) {
$("#drawingCanvas-Signature1").keypress(function(event) {
if (event.keyCode === 13) {
event.preventDefault();
}
});
}
if (false == true) //No I18N
{
$("#drawingCanvas-Signature1").css("pointer-events", "none"); //No I18N
$("#drawingCanvas-Signature1").css("cursor", "default"); //No I18N
}
</script>
</li>
<li tabindex="-1" isunique="false" class="tempFrmWrapper date fieldDisabled" elname="livefield-elem" comptype="5" id="Date1-li" compname="Date1" linkname="Date1" needdata="true" isvisible="true" disableddays="{}" startoftheweek="0"
mandatory="true" page_no="4" page_link_name="Page3" showlabel="true" counteruid="40">
<label class="labelName" for="Date1-date">
<span>Date</span>
<em class="important" aria-label="Required">*</em>
</label>
<div class="subFrmFieldsHidden subFrmFieldsHiddenCont" style="display:none" elemname="fieldHiddenDiv"><em><svg class="icon icon-Denied-1-01">
<use xlink:href="#icon-rules-denied-01"></use>
</svg></em>
<span>N/A</span>
</div>
<div class="tempContDiv" datelocale="en-GB" elname="mm/dd/yy" id="Date1dateDiv" isdisable="true" elemname="fieldContentDiv">
<span>
<div class="calendarCont" elname="calendarContDiv">
<input aria-describedby="hint-Date1 Date1-subInfoText" aria-haspopup="dialog" tabindex="0" name="Date1" elname="date" id="Date1-date" onchange="ZFLive.validateFieldConstraint(this);"
onkeyup="ZFLive.handleKeyNavigationsForDatePicker(this, event, false);" onfocusout="checkDatePicker(this);" autocomplete="off" onclick="ZFUtil.showLiveDatePicker(this)" onfocus="ZFUtil.showLiveDatePicker(this)" type="text"
value="08/22/2024" disabled="" placeholder="" class="hasDatepicker">
<div class="calIconWrapper" role="img" aria-label="Date" elname="imgWrapDiv"><img class="calendarIcon" src="https://static.zohocdn.com/forms/images/spacer.325472601571f31e1bf00674c368d335.gif" title="..."
style="opacity: 0.5; cursor: default;"></div>
<span class="sr-only" elname="arialabel-month" id="Date1-month">Month</span>
<span class="sr-only" elname="arialabel-year" id="Date1-year">Year</span>
<div class="clearBoth"></div>
</div><label class="formSubInfoText" elname="formSubInfoText" id="Date1-subInfoText">MM/dd/yyyy</label>
</span>
<p class="errorMessage" elname="error" id="error-Date1"></p>
<span style="display:none">
<script type="module">
$(function() {
var dateformat = $("#Date1dateDiv").attr("elname"); // No I18N
var actualDateFormat = "MM/dd/yyyy"; // No I18N
var dateLocale = $("#Date1dateDiv").attr("datelocale"); // No I18N
var weekStart = "0"; // No I18N
if (typeof weekStart == ResponseKey.UNDEFINED || weekStart == "") {
weekStart = 0;
}
if (typeof dateLocale == ResponseKey.UNDEFINED || dateLocale == "") {
dateLocale = "en-GB"; // No I18N
}
var disableDays = {};
$("#Date1-date").datepicker({
showOn: "button", // No I18N
buttonImage: "https://static.zohocdn.com/forms/images/spacer.325472601571f31e1bf00674c368d335.gif", // No I18N
buttonImageOnly: true,
dateFormat: dateformat,
showAnim: "drop", // No I18N
changeMonth: true,
yearRange: "1900:2100",
firstDay: weekStart,
beforeShowDay: function(date) {
return ZFUtil.blockDisabledDaysAndHolidays(date, disableDays);
},
beforeShow: function() {
ZFUtil.setDateLimit(this, actualDateFormat, dateLocale);
},
onClose: function() {
$(this).focus();
},
onChangeMonthYear: function(year, month, inst) {
setTimeout(function() {
ZFLive.handleKeyNavigationsForDatePicker(this, event, true);
}, 0);
},
monthNamesShort: CustomDateLocale[dateLocale].monthNamesShort,
monthNames: CustomDateLocale[dateLocale].monthNames,
dayNamesMin: CustomDateLocale[dateLocale].dayNamesMin,
showMonthAfterYear: CustomDateLocale[dateLocale].showMonthAfterYear,
yearSuffix: CustomDateLocale[dateLocale].yearSuffix,
changeYear: true
});
var dateDiv = $("#Date1dateDiv"); // No I18N
var imgElem = $(dateDiv).find('img'); // No I18N
$(imgElem).removeClass("ui-datepicker-trigger"); // No I18N
$(imgElem).addClass("calendarIcon"); // No I18N
$(imgElem).mousedown(function(e) {
e.preventDefault();
});
//$(imgElem).attr("title",""); // Hovering on date picker icon displays the Date field's label
$(imgElem).removeAttr("alt"); // No I18N
/*
When spacing is applied for input fields in Themes, calendar icon needs to vertical aligned with input.
For that img element should be placed inside a div.
*/
var imgWrapDiv = $('<div class="calIconWrapper" role="img" aria-label="Date" elname="imgWrapDiv"></div>');
$(imgWrapDiv).insertBefore(imgElem);
$(imgElem).appendTo(imgWrapDiv);
//The below class add to set z-index
$('#ui-datepicker-div').addClass("calIndex");
$('#ui-datepicker-div').addClass("notranslate");
if (true == true) {
$("#Date1-date").datepicker().datepicker('disable'); //No I18N
}
});
//$("#Date1dateDiv").find('img').addClass("calendarIcon");
</script>
</span>
</div>
</li>
<li isunique="false" class="tempFrmWrapper time fieldDisabled zfSelect2CustomCont" elname="livefield-elem" comptype="6" id="Time1-li" needdata="true" compname="Time1" linkname="Time1" isvisible="true" timeformat="1" mandatory="false"
page_no="4" page_link_name="Page3" counteruid="58">
<label id="Time1-arialabel" class="labelName"><span>Time</span>
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<p style="margin: 0px"><span class="font" style="font-family: "Times New Roman", serif"><span class="size" style="font-size: 12pt">Serendipity<span style="letter-spacing: -0.6pt"> </span>Asset<span style="letter-spacing: 0.1pt">
</span>Recovery<span style="letter-spacing: 0.1pt"> </span>Group,<span style="letter-spacing: -0.05pt"> </span>LLC <span style="letter-spacing: -0.1pt">(“SARG”)</span></span></span><br></p>
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<div>Thank you for entrusting us to work on your behalf to get every dollar you deserve from this settlement. <br></div>
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</form>Text Content
time Email * Jan * Feb * Mar * Apr * May * Jun * Jul * Aug * Sep * Oct * Nov * Dec * SARG REPRESENTATION AGREEMENT This Agreement is solely in regards to the Payment Card Interchange Fee and Merchant Discount Antitrust Litigation, MDL No. 1720 currently pending in the United States District Court for the Eastern District of New York (“Action”). * THE INFORMATION YOU PROVIDE ON THESE FIRST TWO PAGES OF THE FORM WILL BE ADDED TO THE AGREEMENT, WHICH YOU WILL SIGN IN THE FORTHCOMING STEPS. * Did you have a business at any time between 2004-2019 that accepted Visa or Mastercard? * N/A Yes No * What is/was the legal name of the business? * N/A * Select your company type: N/A -Select- Incorporated (Inc.) Company (Co.) Limited Liability Company (LLC) Professional Association (P.A.) Professional Corporation (P.C.) Limited Company (Ltd.) -Select- * What is your relationship with the business? (Title) * N/A -Select- Director Officer Owner Shareholder Manager Other -Select- * Business Tax Identification Number (TIN or EIN) * N/A 9-Digits Numbers Only Please * Estimated annual credit card sales N/A * Referral code N/A If you have a Referral code, please add it here. * p N/A * Closer N/A * Lead Source N/A * Lead Status * N/A * Percentage Fee N/A * Your Name * N/A Required First Name Required Last Name * Email * N/A * Phone * N/A * Address to Send Payment if Eligible * N/A Required Street Address Required City Required State Required Zip * PLEASE REVIEW AND SIGN THE CONTRACT BELOW. * AGREEMENT FOR REPRESENTATION & AUTHORITY TO REPRESENT This Agreement for Representation and Authority to Represent (collectively “Agreement”) is entered into by and between the client identified in the signature block below (“Client”) and Serendipity Asset Recovery Group, LLC. (hereinafter “SARG”). 1. Scope of Representation. Client may be a class member entitled to a payment in a settled class action lawsuit styled: In re Payment Card Interchange Fee and Merchant Discount Antitrust Litigation, MDL No. 1720 currently pending in the United States District Court for the Eastern District of New York (“Action”). The Action concerns excessive fees charged to businesses for accepting Visa and Mastercard cards in violation of antitrust laws. To obtain a payment from the settlement, class members must submit valid claims (“Claims” or “Claim”) to the court-assigned settlement administrator, Epiq Class Action & Claims Solutions, Inc. (“Settlement Administrator”). The Claim forms are not yet available for completion and submission by class members. Once available, failure to submit a valid Claim will result in class members releasing their Claims without receiving payment in return. By this Agreement, Client engages SARG to serve as Client’s agent, and sole representative, to work with the Settlement Administrator to determine if Client is qualified, and if qualified, to submit Client’s Claim on Client’s behalf. 2. SARG'S Fees and Payment to Client. In consideration for representing Client and providing the services outlined in this Agreement, including those in paragraphs 4 and 10, Client agrees to pay SARG a fee of 30% of Client’s gross dollar recovery from the settlement. If Client does not qualify for the settlement, or if there is otherwise no recovery, Client shall not be responsible for the payment of any fees or any costs to SARG. 3. Investigation / Termination for Non-Eligibility. Following Client’s engagement of SARG, SARG will investigate and confirm whether Client is a class member eligible for Claim submission and payment from the settlement. If SARG determines Client is not eligible, or if SARG otherwise chooses not to submit a Claim for Client, SARG may, at any time, terminate this agreement and withdraw from representing Client. In the event SARG terminates the Agreement, SARG will provide email notice to Client advising of its withdrawal. If SARG terminates this agreement, Client will not be responsible for the payment of any fees or any costs expended by SARG. 4. Scope of Engagement / Claim Submission / Authority to Represent. Client has retained SARG to work with the Settlement Administrator (Class Counsel and the Court to the extent necessary or required) to determine if Client qualifies for the settlement, and if qualified, to handle the entirety of the Claim submission process on Client’s behalf. Client acknowledges there is significant value to Client to have SARG represent Client in this capacity. Client acknowledges that there is no legal requirement that class members retain a lawyer to file claims on their behalf, and Client has selected and engaged SARG to handle Client’s Claim and to represent Client’s interest in this Action. Client understands the Settlement Administrator and Class Counsel are available at no cost to Client to assist during the claims-filing period. Notwithstanding, Client prefers to have SARG represent Client. Client grants SARG full, complete, and exclusive authority to communicate with the Settlement Administrator, Class Counsel, and the Court on Client’s behalf, and to make all decisions related to the Action and the settlement on Client’s behalf. Client authorizes SARG to instruct the Settlement Administrator, Class Counsel, and the Court to communicate exclusively and directly with SARG on Client’s behalf. Client authorizes SARG to instruct the Settlement Administrator to send Client’s Claim form to SARG on Client’s behalf (in lieu of the Claim form being sent to Client) to eliminate the possibility Client fails to receive or review the Claim form, and to ensure Client timely submits a completed Claim. Client authorizes SARG to prepare, complete, and submit Client’s Claim to the Settlement Administrator and to communicate as necessary with the Settlement Administrator, Class Counsel, or the Court about Client, Client’s Claim, and the Claim process. SARG may respond to any follow-up requests from the Settlement Administrator or others for additional information or documentation necessary to substantiate Client’s Claim or to support the amount of the proposed Claim payment amount. At SARG’s sole discretion, without consultation with Client, SARG may accept, contest and/or negotiate the Claim payment amount on Client’s behalf. SARG shall instruct Settlement Administrator as to where and the means (check/wire) to send Client’s Claim payment proceeds. SARG has the authority to sign Client’s signature on any document needed to present or support the Claim to the Settlement Administrator, or on any check issued to Client for Client’s Claim payment proceeds for purposes of distributing Client’s share and SARG's fees to each accordingly. 5. Client’s Payment. Client acknowledges Client’s payment will be a pro rata share of the remaining money in the settlement fund after payment of Class Counsel’s attorneys’ fees and costs, Settlement Administration costs, service awards to the Action’s class representatives, and payments allocated to those class members who opted-out of the settlement. It is not possible to know the amount of Client’s payment until all valid claims for all class members are submitted. It is the intention of the parties to have the Settlement Administrator pay Client directly for its share of the settlement proceeds (after deduction for attorneys’ fees) and to pay SARG directly for its fees. Client agrees this agreement shall serve as an instruction to the Settlement Administrator to make payments in that fashion. However, in the event the Settlement Administrator pays SARG for the full amount of Client’s settlement and the payment is in the form of a check in Client’s name, Client gives SARG power of attorney to endorse Client’s name on the check and authorizes SARG to deposit the check in a Trust or Escrow Account, for SARG to retain its fees, and to issue Client’s payment to Client. In the event a check or electronic payment for the full amount of the settlement is sent directly to Client from the Settlement Administrator, Client agrees to within 3 days deliver to SARG its full agreed upon fee by check or wire transfer. 6. Obligation for Payment of SARG's Fees if Client Terminates. Client shall have three days from the date this Agreement is signed to terminate the Agreement. Client will owe SARG nothing if termination is timely made. Cancellation must be made by email to claims@sargrp.com Following three days, Client shall be bound by the terms of the Agreement, including its commitment regarding payment of SARG's fees. 7. Limited Representation & Tax Advice Excluded. SARG is only representing Client for eligibility confirmation and Claim submission and for no other purpose. SARG’s representation does not include any tax- related advice, including, advice relating to the effect of submitting the Claim in the Action or the taxable consequences of receiving payment from the settlement. 8. Association of Additional Counsel. SARG shall have the option to associate with lawyers or law firms. Client will not have to pay any additional fees. 9. Duties of Client. Client agrees to cooperate fully with SARG during the course of representation to advise SARG fully of all pertinent matters, and to provide truthful and accurate information to the best of Client’s knowledge. Client agrees to keep SARG informed of Client’s current mailing address, email address, and telephone number, and in the event any of them change, to email SARG with the new contact information. SARG and Client both agree to be available, upon reasonable request of the other, for telephone calls or email conversations to discuss the settlement, Claim process, or the representation. 10. Client’s Representations and Acknowledgments. Client acknowledges it has not submitted a Claim on its own behalf nor has Client retained any other representative or a lawyer, law firm, or third party to submit a Claim on its behalf. Client acknowledges it will not submit its own Claim in the future unless this Agreement is terminated pursuant to its terms. Client acknowledges it will not sign an agreement with any other representatives, lawyer, law firm, or third party in the future unless this Agreement is terminated pursuant to its terms. In the event SARG learns Client has submitted its own Claim, or there is a duplicative representation of Client by another representative, lawyer, law firm or third party, Client agrees this Agreement with SARG shall supersedes Client’s own submission or any other agreement entered into with any other representative, lawyer, law firm, or third party, regardless of when the submission was made or agreement entered. Client authorizes SARG to use this Agreement as evidence that it intends on SARG and only SARG to handle its Claim. Client represents that its interest in the Action, including its right to the proceeds of the Claim, have not been sold, assigned, or conveyed to any other person or entity, and that the individual signing this Agreement for Client has the authority to execute and bind Client to the obligations hereunder. Likewise, in the event the Client is a dissolved entity, the individual signing this agreement for Client acknowledges the signor is the rightful and lawful successor in interest to the entity entitled to receive the payment under the settlement and that no other party has claimed or is claiming entitlement to some or all of the payment. Client also represents that is not a debtor in any current bankruptcy nor is it a party to any franchise agreement. Client acknowledges SARG is providing value in this matter by using their experience and knowledge to ensure Client’s Claim is properly submitted at an early stage and to ensure that Client’s Claim is filed correctly and timely. Client has access to ask SARG any questions about its representation of Client and to supplement the Claim with additional documentation and information in the event Client or SARG dispute the amount of the settlement offer, and to otherwise have the questions answered to the best of SARG's ability. Further, Client is aware that by working with SARG it is certain to have its Claim submitted when typically, in claims- made settlements in class actions, on average only 2-7% of class members submit claims. This is an important factor in retaining SARG – even if Client could submit the Claim without having to pay a fee to anyone - as it is possible Client would have ignored the Claim form when it is eventually sent by the Settlement Administrator. 11. Sworn Statement. To support the Claim, Client may be required to sign a sworn statement under penalty of perjury. Client authorizes SARG to make that sworn statement and sign on its behalf. By signing this Agreement, the individual signing for Client is signing under the penalties of perjury that the information submitted to SARG in connection with its eligibility for Claim submission is true and accurate, including that the signor has the full authority to sign for Client, the company took Visa and Mastercard as a form of payment between 2004 and 2019, that Client did not file for bankruptcy at any time, and that Client has not assigned its right to the proceeds from the settlement. 12. Confidentiality. The Parties agree to keep the terms of this Agreement confidential between each other, with the exception that the Parties may share the Agreement with the Settlement Administrator, Class Counsel, or the Court. 13. Total Agreement. This Agreement represents the total agreement between Client and SARG regarding SARG's fees and expenses and other terms involving representation of Client by SARG. Any modifications, additions, or other changes to this Agreement shall be made only in writing and signed by Client and SARG. 14. Governing Law. This Agreement shall be governed by the laws of the State of New York, without regard to its conflict of laws and principles. If any term of this Agreement is held invalid or unenforceable, the remainder of the Agreement shall remain in effect. 15. Dispute Resolution; Jury Trial Waiver. If Client and SARG are unable to amicably resolve in good faith any dispute between them arising out of, or in connection with, this Agreement, the dispute must be submitted to arbitration before AAA (American Arbitration Association) for resolution. The arbitration shall be administered by a single AAA arbitrator pursuant to their Comprehensive Arbitration Rules & Procedures, under which Client and SARG shall share equally in the costs of the arbitration. Judgment on any arbitral award may be entered in any court of competent jurisdiction. This clause shall not preclude parties from seeking provisional remedies in aid of arbitration from a court of appropriate jurisdiction. Client and SARG agree that New York law applies in the determination and adjudication of the parties’ rights, responsibilities, and obligations in any such dispute. Client may consult an attorney to evaluate this arbitration requirement. By entering into an agreement that requires arbitration as the way to resolve certain disputes, Client waives the right to go to court to resolve those disputes by a judge or jury. THE PARTIES HERETO AGREE TO BE BOUND BY THE AGREEMENT AS OF THE DATE BELOW. SERENDIPITY ASSET RECOVERY GROUP CLIENT Printed Name: ___ ___ Title: ___ * Signature * N/A E-Signature Field Clear * Date * N/A Month Year MM/dd/yyyy * Time N/A 01 02 03 04 05 06 07 08 09 10 11 12 05 HH : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 58 MM : AM PM AM AM / PM * AUTHORITY TO REPRESENT * On behalf of ___ (Legal Name of Company) (“Client”), I, ___ ___, (Authorized Signor for Client), hereby authorize Serendipity Asset Recovery Group, LLC. (hereinafter “SARG”) and its members and/or employees and agents (collectively “SARG”), to act as my exclusive representatives, and agents in connection with all my rights as a class member entitled to a settlement payment in the action styled: In re Payment Card Interchange Fee and Merchant Discount Antitrust Litigation, MDL No. 1720, currently pending in the United States District Court for the Eastern District of New York (“Action”). SARG has Client’s full authority to work with Epiq Class Action & Claims Solutions, Inc. (“Settlement Administrator”) for purposes of determining Client’s eligibility for participation as a class member in the Action. If the event Client is eligible, Client hereby instructs the Settlement Administrator to send Client’s claim form directly to SARG (without a copy to Client), as SARG will submit the required claim and/or supporting or supplemental information on Client’s behalf. If Client’s signature is required for the claim, SARG has Client’s authority to sign on Client’s behalf. SARG is authorized to file Client’s claim and to communicate with the Settlement Administrator, Class Counsel, and the Court on Client’s behalf, for the entirety of the claims process. The Settlement Administrator shall share any information about Client’s claim with SARG or SARG’s representative as SARG requests. SARG shall have Client’s full authority to accept, reject, or negotiate the amount of Client’s payment on Client’s behalf. SARG shall direct the Settlement Administrator as to where and how to send Client’s share of the proceeds. SARG shall be paid 30% of the gross amount due Client for Client’s claim. Unless SARG instructs Settlement Administrator otherwise, SARG’s 30% share of the payment shall be sent directly by the Settlement Administrator to SARG and Client’s 70% share of the payment shall be sent directly by the Settlement Administrator to Client. Client acknowledges that SARG represents other clients in connection with the submission of claims in this Action and SARG is authorized to submit my claim along with others at the same time. If the Settlement Administrator receives a Claim from Client or any other representative, lawyer, law firm, or third-party purporting to have authority to represent Client, this Authority to Represent shall supersede all and the Settlement Administrator is instructed to ignore the others and work only with SARG. This last instruction is to avoid inadvertent duplication or confusion. CLIENT’S CONSENT AND CLIENT INFORMATION Legal Name of Company: ___ Client’s Tax ID No. (EIN): ___ Title of Signor: ___ Email Address: ___ Address: ___ ___, ___ ___ Telephone Number: ___ * Signature * N/A E-Signature Field Clear * Date * N/A Month Year MM/dd/yyyy * Time N/A 01 02 03 04 05 06 07 08 09 10 11 12 05 HH : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 58 MM : AM PM AM AM / PM * Serendipity Asset Recovery Group, LLC (“SARG”) * Thank you for entrusting us to work on your behalf to get every dollar you deserve from this settlement. Our team will review your submission and submit it to the Action's Portal. * Verification Code * Enter the text in the box below * Next 1/5 * Back Next 2/5 * Back Next 3/5 * Back Next 4/5 * Back Review Submit 5/5 ERROR OCCURRED You haven't verified your email yet, click here to receive a verification email. 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