FEDERAL WAGE CLAIM FORM CLAIM FORM AND RELEASE OF CLAIMS I hereby request a monetary payment from this Settlement. I understand that I previously consented to join this lawsuit and that this Settlement releases all claims I may have under the Fair Labor Standards Act relating to non-compensation for time in the sleeper berth while participating as a contract driver in the CRST Expedited, Inc. Driver Training Program. I understand that I previously designated Class Counsel (as identified in Section 9 of the Notice) as my attorneys for all purposes in connection with this case, including the Settlement. ClaimFormNoHiddenHiddenLastName* Name:* First Last Claimant ID* ***Note: This Lower Portion Will Not Be Filed with the Court*** If your address has changed, please update your address below. Phone Number:*Street Address:* Address Line 1 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Code E-mail Address:* Unique IDEmailThis field is for validation purposes and should be left unchanged.
