Company Name
Federal Tax Identification Number
Street Address
City
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First Name
Last Name
Title
Phone
Email Address
Annual Revenue
Number of Employees
I am submitting this request on behalf of a Business or Organization, not for myself as an individual
I am authorizing US Merchant Payment Solutions
to release merchant processing information for my company to Financial Recovery Strategies only for the purpose of verifying and validating the claim.
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.
Contact Information