In the Matter of JPay, LLC - Update Address Form

Update address form

To receive a refund payment, we must have your current mailing address. To provide your mailing address, please fill out the form below by entering your name, address, and the Unique ID included in the email you received. You may also submit this information by email or mail by downloading the preformatted Address Form and following the instructions on the form. Address information must be submitted no later than April 13, 2023.

Unique ID:

To help process your submission, please provide the Unique ID from your email.*

Where can I find my Unique ID?

Claimant Contact Information:

First Name:*

Middle Initial:

Last Name:*

Country:*

Address Line 1:*

Address Line 2:

Address Line 3:

Address Line 4:

Address Line 5:

City:*

State/Territory:*

Province:*

ZIP Code:*

Postal Code:*

Phone Number:

Email Address:*