Used to update payment information via DD widget. Step 1 of 2 50% InstagramThis field is for validation purposes and should be left unchanged.This field is hidden when viewing the formhidden claimant id*This field is hidden when viewing the formhidden LastName*This field is hidden when viewing the formhidden PM*ADDRESS AND/OR PAYMENT METHOD UPDATEGENERAL INSTRUCTIONSPlease follow the steps on the next pages to review and update your information.You will first be asked to review your address and confirm or update it.• If your address is correct, select Confirm My Address and continue.• If your address has changed, select Update My Address and enter your new information.After that, you will choose a payment method. CLASS MEMBER INFORMATION NAME:* Business Name Current Address:* Mailing Address (Street Address including apartment number, suite, floor, or other pertinent detail, or PO Box) 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 Please choose one option:* Update My Address Confirm My Address Updated Address:* Mailing Address (Street Address including apartment number, suite, floor, or other pertinent detail, or PO Box) 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 Email Address:* Telephone Number with area code:*Claimant ID:*This is the 8-digit alpha-numeric identification code included in the Notice sent by mail or email Payment SelectionBased on our records, your current payment method is as your payment method. Please indicate below if you would like to update this selection. This field is hidden when viewing the formPlease choose one option:* Update My Payment Method Confirm My Payment Method Please select one payment method for receipt of any Settlement payment to which you are determined eligible: This field is hidden when viewing the formPayment Token*Payment Method:*SignatureCheckbox Consent* I verify the information provided on this form is accurate. Date:* ClaimFormNo
