1Update Your Information2Select Payment Option Payment Form Number CLAIM FORM Please select whether you want to receive your payment as a check or as an electronic payment. Please note that if you select payment by check, the check will expire 180 days after the date of issuance to you and said amount will be provided in accordance to the state in which you are located in accordance with the escheatment laws of the state in which you are located. All information provided is subject to verification by the Claims Administrator. The Parties have the right to seek discovery to further verify the accuracy of the information contained on this claim form, including requiring you to appear for an expedited deposition or in court, where you may be required to testify under oath. This form must be submitted by April 30, 2024, or else your claim will not be considered timely. Claimant ID*Name* First Last Address* 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 Telephone* Greenridge Payment Option - Step 2Please select the Payment Option by which you would like to receive your payment and complete the steps as prompted. If you would like to receive a paper check, please click the link provided at the bottom of the digital payment options displayed after the sentence starting with “if you prefer to receive a paper check...” Chosen Payment Method*This field is hidden when viewing the formPayment Token*Signature* I certify, under the penalty of perjury, that the above information is true and accurate.