Submit a Claim

Claim Form

Contact Information

Provide your name and contact information below. You must notify the Claims Administrator if your contact information changes after you submit this form. This information will be used to deliver your monetary compensation and communicate with you, if necessary

First Name

Last Name

Address 1

Address 2

City

State

Zip Code

Phone

Claim Information

1. What was the the name of the bank that assessed your account two (2) out-of-network fees for a balance inquiry during a single visit to an ATM located in a 7-Eleven convenience store between May 1, 2018 to November 16, 2021?*

Bank Name

2. Provide the last four digits of the current or past account that was assessed the two (2) out-of-network fees for a balance inquiry referenced in question 1.*

XXXX

Payment Election

Confirmation of Class Membership, Acknowledgement & Signature

By checking this box, I declare that between May 1, 2018 to November 16, 2021, I was assessed two out-of-network fees for a balance inquiry during the same visit at a FCTI ATM.*

By signing below, I acknowledge that I have seen the Publication Notice in this Action and I am a member of the Nationwide Settlement Class of persons described in the Notice. I agree to release all the claims, known and unknown, stated in Section XIII of the Settlement Agreement. I submit to the jurisdiction of the Superior Court of California, County of San Diego, with regard to my Claim and for purposes of enforcing the release of claims stated in the Settlement Agreement. I am aware that I can obtain a copy of the Long Form Notice and Settlement Agreement at on this website, www.FCTIClassAction.com, or by writing to the Settlement Administrator at the email address: info@FCTIClassAction.com, or the postal address: FCTI Settlement, PO Box 25228, Santa Ana, CA 92799. I agree to furnish additional information to support this Claim if required to do so.

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct to the best of my knowledge.

Signature

Date

Important Note: The Settlement Administrator and/or FCTI may verify your Claim.