Submit a Claim

Claim Form

Contact Information

Provide your name and contact information below. This information will be used to deliver your Settlement Voucher and communicate with you if any problems arise with your Claim.You must notify the Settlement Administrator if your contact information changes after you submit this claim form.

First Name

Last Name

Address 1

Address 2

City

State

Zip Code

Phone

Credit Monitoring Services

All Settlement Class members are eligible to receive three (3) years of Credit Monitoring Services. This includes:

real time monitoring of the Settlement Class member’s credit file at a credit bureau;
dark web monitoring;
identity theft insurance coverage for up to $1,000,000.00; and
fully managed identity recovery services.

Would you like to receive three (3) years of 1-bureau credit monitoring services?*

YesNo

Note: If you elect credit monitoring, you will need to follow instructions and use an "activation code" that you receive after the Settlement is final. Credit monitoring services will not begin until you use your activation code to enroll. Activation instructions will be sent to the email address you provided in the Contact Information section above.

Settlement Benefits

All Settlement Class Members are eligible for a Cash Payment but may select only one Cash Payment, not both. Cash Payment options are:

Cash Payment A - Documented Losses: If you incurred actual, documented out-of-pocket losses due to the Data Incident, you may file a claim for reimbursement of up to $4,000.00 per Class Member;OR
Cash Payment B - Flat Cash Payment: You may elect to receive a flat cash payment in the amount of $100.00 (subject to pro rata adjustment)

Please select your Settlement Benefit.*

I would like to claim for Documented Losses.I would like to claim for the Flat Cash Payment.

Payment Election

Please select one of the following payment options, which will be used should you be eligible to receive a settlement payment. Please remember that the Court in charge of this case still has to decide whether to approve the Settlement. Payments will be made once the Court approves the Settlement and after appeals are resolved. Please be patient.

IMPORTANT NOTES:

For E-Mastercard, PayPal, Venmo, and Zelle payments, if there are any discrepancies, if the account is no longer active, or if the Settlement Administrator deems that payment cannot or should not be made based on the provided information, the Claims Administrator will either contact you for clarification or be authorized to default to a Check payment.
If domestic or international payment limits apply to your payment, you may receive more than one transmission or you may default to a Check payment.
Venmo and Zelle payments cannot be made to accounts outside of the United States.
Payments by Check will be made out to the Name on this Claim Form and mailed to the address on this Claim Form.

Attestation & Signature

By submitting this Claim Form, I swear and affirm that the information provided in this Claim Form, and any supporting documentation provided is true and correct to the best of my knowledge. I understand that my claim is subject to verification and that I may be asked to provide supplemental information by the Settlement Administrator before my Claim is considered complete and valid.

Signature

Date