Company Name
Federal Tax Identification Number
Street Address
City
State
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AK
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DE
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IL
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Zip/Postal Code
First Name
Last Name
Title
Phone
Email Address
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Acknowledgement of Request
By clicking the checkbox you acknowledge that you have read the related summary above. If you believe you are eligible to file a claim for the settlement please select the checkbox and click the “Submit” button below to begin the electronic authorization process to work with FRS.
Contact Information