1Update Your Information2Select Payment Option ClaimFormNoVerify/Update Personal Information - Step 1CLASS ACTION SETTLEMENT CLAIM FORMHise vs. Enhanced Recovery Company, LLCCircuit Court of St. Clair County, IllinoisCase No. 21-L-0148 IMPORTANT: You have been identified as a claimant who is likely a Class Member. If you are a Class Member and fail to submit this Claim Form, then you will receive nothing but still be bound by the settlement. If you are a Class Member and you submit this Claim Form, then you will receive a portion of the settlement. Only those claimants who fall within the definition of “Class Member” in the accompanying Class Notice will receive a settlement payment, and not all who receive the Class Notice are Class Members. There is no cost to you to submit a Claim Form. Claimant ID(Required)Name(Required) First Last Address(Required) Street Address Address Line 2 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(Required) Phone Hise v. Enhanced Recovery Company Payment Option - Step 2Please select the Payment Option by which you would like to receive your payment and complete the steps as prompted. YOU MUST CONTINUE TO THE NEXT SCREEN TO ELECTRONICALLY SIGN AND FINALIZE YOUR CLAIM. Chosen Payment Method(Required)This field is hidden when viewing the formPayment Token(Required)Signature(Required) I wish to make a claim associated with the class action settlement, and all information provided above is true and correct to the best of my knowledge.
