YOUR CONTACT INFORMATION AND MAILING ADDRESS Sample Clauses

YOUR CONTACT INFORMATION AND MAILING ADDRESS. Provide your name and contact information below. You must notify the Settlement Administrator if your contact information changes after you submit this form. Name Co-Owner’s Name Street Address City State Zip Code ( ) - ( ) - Daytime Phone Alternate Phone YES / NO Email Address Do you consent to receive official information about the claim via email? BENEFIT SELECTION (select ONE of the three benefits below) Replacement and Repair: Claimants will receive $1.00 per square foot of Replacement Area for replacement siding and $4.75 per square foot of Replacement Area to contribute to additional repair costs. Within 30 days of final approval of the Claim, the Claims Administrator will pay 30% of the total compensation available under this option. Within 30 days after proof of repair is accepted by the Claims Administrator, the Claims Administrator will pay the remaining 70% of Additional Costs. or Quick Cash Option: This Option provides compensation solely for Siding exhibiting Qualifying Damage and not the 30% or greater Elevation Replacement Area. The Claims Administrator will pay the Settlement Class Member $4.25 per square foot of Qualifying Damage within 30 days of final approval of the Claim. or Cash Option with Proof of Repair: This Option allows a Settlement Class Member with Qualifying Damage that does not exceed 30% of an Elevation to be reimbursed for an entire Elevation upon proof of repair of the entire Elevation. Specifically, the Claims Administrator will pay $4.25 per square foot of Qualifying Damage within 30 days after final approval of the Claim, and $4.25 per square foot of the remaining portions of the Elevation. Original Owner or Permitted Transferee: Do you currently own the property on which the Siding is installed? YES NO If you answered NO: Did the current owner of the property assign the rights recover under this settlement to you? If so, please enclose the agreement memorializing such assignment? YES NO What was the approximate installation date (month/year) of the Fiber Cement Siding on your property? / Month Year Total Square Footage of each structure on the property with Siding (outside footprint if known; if not, interior square footage Total square feet or quantity of Siding on each elevation: North South East West AMOUNT OF SIDING INSTALLED / DAMAMGED ON PROPERTY Total Square feet or quantity of Siding that is damaged: Total square feet or quantity of damaged Siding on each elevation: North South East West The number of stories...

YOUR CONTACT INFORMATION AND MAILING ADDRESS. Provide your name and contact information below. You must notify the Claim Administrator if your contact information changes after you submit this form. First Name Last Name Street Address City State Zip Code Email Address