FORM COMPLETION INSTRUCTIONS
Please provide the information requested below and select “Submit”. You will receive an email containing a DocuSign document and a second email with instructions for completing the DocuSign agreement. You will receive a copy of the completed agreement when it is signed.
Upon receipt of the completed forms, J.E. Lawrence & Co. will file your claim.
IMPORTANT NOTICE: Claims are based on unique tax IDs. If you have two or more locations that share the same unique tax ID, you only need to submit one of those locations on this landing page. Your claim will be based on the combined volumes of all of your locations that share that same unique tax ID. The claim administrator will do this automatically based on the records that Visa and MasterCard submitted to them. If you submit more than one location that shares the same unique tax ID, you will not receive a DocuSign agreement for those subsequent locations.
