File an E-Claim - TERMINIX CONSUMER FUND

IMPORTANT NOTICE: The July 15, 2021 deadline for former Terminix customers to submit a proof of claim form for a rebate or refund or to submit a reinstatement form has expired. The Receiver is now in the process of adjudicating and paying those claims from former customers, and paying the claims of existing customers (who did not need to submit a proof of claim form). Please be patient, but if you have any questions about the status of your claim, feel free to contact the Receiver’s office by email (terminixfund@lklsg.com), by phone (786-347-2564), or by facsimile (305-403-8789). THE ONLY CLAIMS THAT CAN STILL BE MADE AT THIS TIME ARE THOSE FOR TERMITE-RELATED PROPERTY DAMAGE FOR PROPERTY IN THE STATE OF ALABAMA.

IF YOU ARE AN EXISTING OR FORMER TERMINIX CUSTOMER WITH PROPERTY IN THE STATE OF ALABAMA, YOU MAY BE ENTITLED TO A REFUND OR OTHER RELIEF IF YOU COMPLETE AND SUBMIT THIS CLAIM FORM TO THE COURT-APPOINTED RECEIVER. PLEASE REFER HERE FOR ADDITIONAL INFORMATION. DO NOT SUBMIT A CLAIM IF YOU DO NOT OWN PROPERTY IN THE STATE OF ALABAMA.

1. Consumer Information

Consumer Name

Name of party who signed contract (if different)

Date Terminix contract was signed

Terminix contract number

You may provide your Terminix Customer Number or Terminix Sales Agreement Number

Mailing Address

City

State

ZipCode

Phone Number

Mobile Number

The property serviced by Terminix is the same address as my mailing address.
yesno

If "NO" above, please enter serviced property address, with city, state and zip code

2. Refund Claim; Former Customers

If you were a Terminix customer that resides in Baldwin County or Mobile County, and you cancelled your contract with Terminix due to Terminix increases in annual renewal payments for 2019 or 2020, you are eligible to receive one of the following:

A one-time payment of 650.00; or
An amount equal to the difference between your 2018 Terminix contract price and the amount you paid to purchase a termite contract with another provider in the years 2019 or 2020.

OPTION 1: If you would like to receive the one-time payment of $650.00, please sign here, Skip to number 3, and complete the final section (Attestation) of this claim form:
Enter your full name as your Electronic Signature and continue to Number 3

OPTION 2: If you would like to receive the difference between your 2018 Terminix contract price and the amount you paid to your new provider in 2019 or 2020, please sign here, complete the rest of this page, and complete the final section (Attestation) of this claim form:
Enter your full name as your Electronic Signature, and answer the questions below.

Name of provider you signed a contract with for the year 2019; or

Name of provider you signed a contract with for the year 2020:

Amount you paid to the new provider for the year 2019; or

Amount you paid to the new provider for the year 2020:

3. Property Damage Claims

If you are an existing or former Terminix customer in the State of Alabama, and you own a property serviced by Terminix that you believe contains termite damage, you may be entitled to a payment for those damages.

Are you an existing or former Terminix customer:
existingformer

Have you already tried to resolve this dispute with Terminix directly since the issuance of the Consent Judgment on December 2, 2020:
yesno

Date damage occurred

Date you contacted Terminix about your property damage claim

Date Terminix rejected your property damage claim

Please describe the nature of the damages and estimated amount of the damages incurred

Please describe why you believe Terminix is responsible for your damages

Have the damages been repaired already; if so, by whom, and what was the full amount paid:

4. Other Claims

If you are an existing or former Terminix customer in the State of Alabama, and you have been unable to resolve your dispute with Terminix, you are entitled to submit that dispute to the Receiver.

Are you an existing or former Terminix customer:
existingformer

Have you already tried to resolve this dispute with Terminix directly since the issuance of the Consent Judgment on December 2, 2020:
yesno

Please describe the nature of your dispute and, if applicable, the cost or amount paid to resolve the dispute:

ATTESTATION

Supporting Documents: Please attach copies of any documents that support your claim, such as: (a) a copy of your contract with Terminix; (b) a copy of your contract with another provider for the years 2019 and/or 2020 (if applicable); (c) copies of your cancelled checks to your new provider for the years 2019 and/or 2020, or other documentation reflecting payments made by you to your new provider for the years 2019 and/or 2020 (if applicable); (d) copies of pictures of property damage (if applicable).

Click to choose documents to upload
To select multiple documents, hold the CTRL key while clicking on the documents

DO NOT SEND ORIGINAL DOCUMENTS. THE DOCUMENTS YOU SEND MAY BE DESTROYED AFTER SCANNING. If the documents are not available, please explain below:

I declare under penalty of perjury that the above information is correct.
Date

Enter your full name as your Electronic Signature