Your Claim Form has been submitted successfully.
Please print this page for your records.
Your Claim Details
Submitted Claim ID: | |
Confirmation Code: | |
You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records. | |
CLAIM INFORMATION | |
First Name | |
Last Name | |
Street Address | |
City | |
State | |
Zip Code | |
Email Address |
Signature | |
Date |
If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Questions@PlaidSettlement.com.
Click here to edit your Claim.