Intake Form - merchantrefund.com

How To Get Started

To initiate the process and join the settlement, please complete the form to the right for EACH of your businesses.

This will provide our operations team with the necessary information to prepare the required documents for e-signature. Once the documents are executed, the law firm will commence work with the legal counsel.

Company Legal Name *

TAX ID# *

Entity Type *

Estimated Total Sales Volume for Visa / Mastercard '04-'19 *

Country *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Phone # *

Signers Name *

First

Last

Signers Title *

Signers Mobile Number *

Signers Email *

Referred By *

Please include all Referral Sources

Comments

If you have any comments or questions, please include them here

Next Step: You will receive an email from DocuSign referencing the M Fox Law Group and / or Level Advisors for your Electronic Signatures. It will consist of the Authorization to Represent and Contingency Agreement. The email will be sent within 3 business days from receipt of the intake form.

Terms *

*I/we appoint Julio Gudino and or representatives of JDAC Consulting Group as my/our authorized agent with regard to this claim. Please include Julio Gudino at julio@jdacgroup.com on all communications.

JDAC Consulting Group LLC

Location

2900 S Harbor Blvd
Santa Ana CA 92704
United States

Contact

562-378-4908 julio@jdacgroup.com