Submit Claim | Allstate Call TCPA Settlement

The deadline for submitting this proof of claim form is May 20, 2022

I. Provide Your Contact Information:

Name *

Street Address 1 *

Street Address 2

City *

State *

Postal Code / Zip Code *

Email Address *

Contact Phone Number *

* Required Fields

II. PHONE NUMBER ON WHICH YOU RECEIVED A CALL OR CALLS:

Your phone number must be listed in our records as one of the phone numbers that was called by AGAX Leads on behalf of Allstate included as part of the settlement. If you are not certain which of your phone numbers may have been called, you may list each of them separately.

Phone Number 1

Phone Number 2

Phone Number 3

III. Fill Out and Sign the Following Attestation:

By submitting this Claim Form, I certify that I received call(s) seeking to sell Allstate insurance products or services.

Signature *

Date

Carpenter v. Allstate Insurance Company

Case No. 2:21-cv-03381-EAS-EPD

UNITED STATES DISTRICT COURT FOR THE SOUTHERN DISTRICT OF OHIO

The deadline for submitting this proof of claim form is May 20, 2022

Your Claim Form has been submitted successfully.

Submitted Claim ID:
Confirmation Code:
You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
CLAIM INFORMATION
Name
Street Address 1
Street Address 2
City
State
Zip Code
Email Address
Contact Phone Number
Call Phone Number 1
Call Phone Number 2
Call Phone Number 3