"*" indicates required fields Step 1 of 2 - Update Your Information 50% ClaimFormNumber Burnett v CallCore Media CASE NUMBER: 4:21-cv-03176 CLAIM FORM This form must be submitted by June 19, 2024. Please select on the next page whether you want to receive your payment as a check or as an electronic payment. Please note that if you select payment by check, the check will expire 120 days after the date of issuance to you and said amount will be provided in accordance with the escheatment laws of the state in which you are located. All information provided is subject to verification by the Claims Administrator. The Parties have the right to seek discovery to further verify the accuracy of the information contained on this Claim Form. This form must be postmarked or received by June 19, 2024 or else your claim will not be considered timely. You can submit this electronically on this website or via mail at prerecordedsettlement@atticusadmin.com by sending to CallCore TCPA Settlement, c/o Atticus Administration, PO Box 64053, Saint Paul, MN 55164. To view and print a copy of the paper Claim Form, please click HERE. Name* First Last Current Street Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Claimant ID* CallCore Payment Option - Step 2Please select the Payment Option by which you would like to receive your payment and complete the steps as prompted. If you would like to receive a paper check, please click the link provided at the bottom of the digital payment options displayed after the sentence starting with “if you prefer to receive a paper check...” Chosen Payment Method*This field is hidden when viewing the formPayment Token*Signature* I verify the information provided is accurate.
