Election Form

INSTRUCTIONS: FILL OUT AND RETURN ELECTION FORM by September 13, 2024

Provide your name and contact information below. It is your responsibility to notify the Claims Administrator of any changes to your contact information after the submission of your Election Form. You must keep a current address on file with the Settlement Claims Administrator and Class Counsel, along with a valid phone number and email address for updates.

"*" indicates required fields

Unique Code*

4-Digit PIN*

If you received a Notice indicating that you are part of the Settlement Class, you will have a 10-character alphanumeric "Unique ID" and a 4-digit "PIN". This will be found on the top of the Notice regardless if you received it via mail or email.

If you did not receive a Notice or have lost your Notice, please contact the Settlement Administrator by calling (833) 339-0196 (Toll-Free).

The unique code and/or PIN you entered does not match our records.

First Name*

Last Name*

Email*

Phone*

Select one option below:*

OPTION ONE: RECEIVE CASH PAYMENT BY CHECK

OPTION TWO: RECEIVE ELECTRONIC PAYMENT

Electronic Payment Method*

PayPal

Venmo

I would like to receive my Settlement Benefit by paper check via First Class Mail at the following address:*

Mailing Address APT or STE # City State / Province / Region ZIP Country

I would like to receive my Settlement Benefit via PayPal.

PayPal Account

I would like to receive my Settlement Benefit via Venmo.

Venmo Account Username

Electronic Signature*

Today's Date*

Name

This field is for validation purposes and should be left unchanged.

ELECTION FORM

INSTRUCTIONS: FILL OUT AND RETURN ELECTION FORM by September 13, 2024

Deadlines:

Updates:

Montalvo v. California Lutheran University Settlement Claims Administrator Contact Information: