KLINGENSMITH V. BP PRODUCTS NORTH AMERICA, INC.
space
Home Page
Court Documents
Notice
Submit Online Claim Form
Claim Form(Printer Friendly Version to Submit by Mail)
Contact Information

Online Claim Form

If you intend to include receipt(s) with the submission of your Claim Form, you are required to download a copy of the Claim Form and mail it to the Settlement Administrator.

To make a claim under the Settlement, please provide the following information. All fields * are required.


*First Name
*Last Name
*Address
*City
*State
*Zip
*Phone         
*I am NOT including receipts with the Claim Form, but I certify that I used a debit/credit card at the BP service station.  
*Enter the location of the BP service station 
City                        State
*Enter the approximate date of visit    

*Enter the last four digits of the account number on the debit/credit card used  
*I understand that the foregoing information may be used for purposes of verifying my claim, and I certify, under penalty of perjury, that the statement and information containing herein is truthful and accurate.