FCS Class Action - Update Address

Update Address Form

Using the form below, please provide us with your new address information. Do NOT use this form to update your name. If you have a name change, please contact the Settlement Administrator directly at 1-888-509-2623, as you will be required to provide documentation.

Updated Contact Information:

Please select what type of claimant you are:*

First Name:*

Middle Initial:

Last Name:*

Business/Entity Name:*

Representative Name:*

Patient/Plan ID Number:

Country:*

Address 1:*

Address 2:

Address 3:

Address 4:

Address 5:

City:*

State:*

Province:*

ZIP Code:*

Postal Code:*

Phone Number:

Email Address:*

Previous Information:

Please provide your previous address.*

Country:*

Address 1:*

Address 2:

Address 3:

Address 4:

Address 5:

City:*

State:*

Province:*

ZIP Code:*

Postal Code:*