If you received a personalized notice in the mail or via email with a Claim ID and Confirmation Code, please enter the codes you were provided below. See illustration location HERE.

Please remember to enter the full Claim ID exactly as it appears on your personalized Notice, (i.e. 12345678).

If you did not receive a personalized Notice in the mail or via email, click below to complete a Claim Form.

The deadline for submitting this proof of claim form is

CLASS MEMBER CONTACT INFORMATION

* Required Fields

PAYMENT PREFERENCE

Payments will be made via PayPal to the email address above unless you elect to receive a check by mail or provide a different PayPal email address.

PayPal
Check by Mail
CERTIFICATION AND SIGNATURE

Signature Required: By signing the below, you certify that the following statement is true:

I was harmed or emotionally distressed when Inflection labeled my offense as “offense class: violence.”

Your Claim Form has been submitted successfully.

Please print this page for your records.

Your Claim Details
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
First Name
Last Name
Street Address
Street Address 2
City
State
Zip Code
Email Address
Phone Number
Signature
Date

If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@BackgroundReportSettlement.com

Click here to edit your Claim.

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