CLASS MEMBER NAME AND CONTACT INFORMATION. Provide your name and contact information below. You must notify the Settlement Administrator if your contact information changes after you submit this form. First Name Last Name Street Address City State Zip Code Phone Number Email Address
Appears in 2 contracts
Samples: Settlement and Release Agreement, Settlement Agreement
CLASS MEMBER NAME AND CONTACT INFORMATION. Provide your name and contact information below. You must notify the Settlement Claims Administrator if your contact information changes after you submit this form. First Name Last Name Street Address City State Zip Code Phone Number Email Address
Appears in 2 contracts
Samples: Settlement Agreement and Release, Settlement Agreement and Release
