Opt-Out Request Form

If you would like to opt out of this lawsuit, please fill out this form completely, certify it and then submit it. Opt-Out Requests must be submitted no later than July 5, 2019.

Contact Information:

Please select the type of Claimant you are:*

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Claim Information:
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Affected Phone Number:

Certification:
By checking this box, I affirm that I wish to be excluded from the monetary portion of this Class Action Settlement. I understand that by opting out of this Class Action Settlement, I will not be eligible to receive any money that may result from any trial or settlement of this lawsuit, if there is one. I do not wish to receive monetary compensation under the terms of any judgment or settlement or to otherwise participate in the monetary portion of this Class Action Settlement. I further understand that by opting out, all personal representatives, spouses, and relatives who on account of a personal relationship to me might assert a derivative claim for money will be deemed to have opted out as well. *

PLEASE ONLY COMPLETE THIS CERTIFICATION IF YOU WISH TO OPT OUT OF THIS LAWSUIT.