Submit a Claim - Page 1

Contact Information
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Claim Information

Please provide the Affected Fax Number at which you or your company received faxes between July 14, 2009, and June 9, 2010.*

Please provide any additional Affected Fax Number(s) you or your company received faxes between July 14, 2009, and June 9, 2010.

The Settlement Administrator will verify that the fax number(s) you provide appear(s) in the existing records related to the case before approving your claim. The parties also have the right to audit this Claim Form, verify your statements, and dispute any claims.

Please Note: If you have more than 5 Affected Fax Numbers, you may file another Claim Form after completing this one.

If the Settlement is granted Final Approval and your claim is accepted, you will be mailed a check representing your share of the Settlement Fund, subject to the verification process noted above. This process takes time, so please be patient.

Certification
  By checking this box, I declare under penalty of perjury that between July 14, 2009, and June 9, 2010, I or my company subscribed to the fax number identified above and that faxes were received at such number, including faxes from the Tampa Bay Buccaneers. I further certify that the foregoing is true and correct to the best of my knowledge.*