Settlement Pending

First Name

Last Name

Email

Phone

Service Order Number

If a check or a replacement is being sent to you, it will be sent to this address. Please verify that your address is entered correctly before submitting this form.

Street Address

City

State/Region

Zip Code

• Yes, I accept the settlement provided by New Leaf Service Contracts, Inc.
• I would like to speak with a settlement representative before I make a decision.

By typing my name below, I am consenting to the option selected above and to the following terms:
I understand that multiple copies of my above submission are kept on file at New Leaf Service Contracts for verification purposes. I have reviewed the information above and hereby certify that it is accurate and true. I have been given ample time to review my settlement offer and to ask any questions concerning my settlement offer. I understand that by submitting my response using this form, I may be, depending on the selection above, consenting to receive the exact settlement offered by New Leaf Service Contracts, Inc. as governed by my Terms and Conditions. I also understand that this offer is final and cannot be changed, updated, or negotiated.

Electronic Signature

Today's Date: