Complete the fields below to submit a Claim under the Settlement described in the Notice.
You must complete this Claim Form, which must be submitted no later than August 23, 2019, to be eligible to receive a payment under this Settlement. Your response will be checked against records produced in this case.
1. Identify yourself:
NOTE: If you received a post card with notice informing you of your right to
file a claim, the phone number(s) at which the calls at issue were received is listed on that notice.
2. Verify that you are a member of the Settlement Class described in the Notice:
3. Sign this Claim Form and submit it to the Settlement Administrator:
After you complete this Claim Form, electronically sign it below and submit it online or by United States Mail to the Settlement Administrator at the following address:
Philip Charvat v. National Holdings, et al.
c/o A.B. Data, Ltd.
P.O. Box 173077
Milwaukee, WI 53217
CLAIM FORMS MUST BE POSTMARKED BY AUGUST 23, 2019, TO BE ELIGIBLE FOR PAYMENT UNDER THIS SETTLEMENT