If you received a personalized notice in the mail or via email with a Notice ID and Confirmation Code, please enter the codes you were provided below.

Please remember to enter the full Notice ID exactly as it appears on your personalized Notice, (i.e. 12345678).

If you did not receive a personalized Notice in the mail or via email, click below to complete a Claim Form.

The deadline for submitting this proof of claim form is

Contact Information

Provide your name and contact information below. You must notify the Settlement Administrator if your contact information changes after you submit this form.

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e-Toll Related Charges

Defendants maintain records of the e-Toll-Related Charges Class Members paid during the Class Period for Avis and Budget rentals. Defendants’ records will be used to calculate the value of your claim under the terms of the Settlement Agreement. Your estimated Settlement Payment is listed below. If you do not want to rely on Defendants’ records, you may submit any and all records or other proof to show your payment of e-Toll-Related Charges on Avis or Budget rentals during the Class Period. Upload copies of your proof with this claim submission.

Defendants maintain records of the e-Toll-Related Charges Class Members paid during the Class Period for Avis and Budget rentals. Defendants’ records will be used to calculate the value of your claim under the terms of the Settlement Agreement. You can obtain the information used to calculate the value of your claim by calling the Settlement Administrator at 1-844-448-0078, or by emailing Info@eTollSettlement.com. If you don’t want to rely on Defendants’ records, you may submit any and all records or other proof to show your payment of e-Toll-Related Charges on Avis or Budget rentals during the Class Period. Upload copies of your proof with this claim form. Please keep any original documents.

Estimated Settlement Payment:

Select one of the following:

I agree to be paid based on the e-Toll-Related Charges contained in Defendants’ records:

List Transactions

You do not need to fill out this chart unless you disagree that your payment will be based on the e-Toll-Related Charges contained in Defendants’ records.

You do not need to fill out this chart unless you disagree to be paid based on the e-Toll-Related Charges contained in Defendants’ records.

Approximate Rental
Date (Month, Year)		 Vehicle Pickup
Location		 e-Toll-Related
Charges You Paid		 Refunded
Amount†		 Third Party Billed‡

†If you received a refund from Avis Budget Group, Inc. or the Highway Toll Administration LLC for this transaction, enter the refunded amount here.

‡If the e-Toll-Related Charges were paid directly by a third-party through a central billing account, check “YES” here.

Supporting Documentation

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    Payment Method

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    Fill Out and Sign the Following Attestation

    By signing below, I certify that, at the time I used the e-Toll service, I was not aware that such use required payment of additional fees or charges.

    I declare under penalty of perjury under the laws of the United States of America that the information provided on this form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review.

    Your Claim Form has been submitted successfully.

    Please print this page for your records.

    Your Claim Details
    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
    CLAIM INFORMATION
    First Name
    Last Name
    Street Address
    Street Address 2
    City
    State
    Zip Code
    Email Address
    Phone Number
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at Info@eTollSettlement.com

    Click here to edit your Claim.

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