File a Claim Online AAA South Jersey Settlement Claim Form Step 1 of 3 - Claimant Information 0% CLAIMANT INFORMATIONThe Settlement Administrator will use this information for all communications regarding this Claim Form. If this information changes, you MUST notify the Settlement Administrator in writing.First and Last Name*(as you would like it to appear on your check if eligible for payment)Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Best Phone Number*Alternate Phone NumberEmail* Enter Email Confirm Email Payment OptionsPlease indicate whether you are a CURRENT or FORMER member*I am a CURRENT memberI am a FORMER memberMembership Number*The membership number is located on your membership card.Please indicate the type of relief you are claiming*$11 Cash2 month extension of current AAA membershipPlease indicate the type of relief you are claiming*Receipt of $11 Sign & DateThe information on this form is true and correct to the best of my knowledge. I agree to participate in the settlement. I understand that my Claim Form may be subject to audit, verification and review.Signature of Claimant*Please type your name. This will be considered your signature. Date* FormID EmailThis field is for validation purposes and should be left unchanged.