Submit Claim | Venerus, et. al. v. Avis Budget

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Claim Form

If you rented a vehicle from Avis Budget in Florida after June 12, 2008 and through December 31, 2015, pursuant to a prepaid voucher, and your Rental Receipt contained the notation “SLI .00/Day Accepted” or “ALI .00/Day Accepted, to submit a claim, please: (1) provide your full name; (2) provide EITHER the rental agreement number (upper left corner of rental contract) or the reservation number (bottom right of the rental contract) or the year in which your rental(s) occurred; (3) provide your address; (4) sign and date this form by following the instructions below; and (5) submit the completed form on or before January 20, 2022.

A sample Rental Contract can be viewed here.

Name *

Country *

Primary Address *

Primary Address continued

City *

State *

Zip Code *

Email Address *

Reservation or Rental Agreement Number

+ Add Reservation or Rental Agreement Number

Year of Rental

+ Add Rental Year

Payment Method

If your claim is determined to be valid and timely, you can receive payment in one of the three options below. Please select the method by which you wish to receive payment, including the necessary information depending on which option you select. You can only select one option.

OPTION 1: I wish to receive the Claim Payment via an electronic Mastercard gift card, e-mailed to the following e-mail address:

OPTION 2: I wish to receive the Claim Payment via physical check, mailed to the following address:

Country *

State *

OPTION 3: I wish to receive the Claim Payment via electronic payment to my account with PayPal or similar company or e-banking payment. If you are selecting Option 3, the Settlement Administrator will email you at your email address to ask you for the information needed, including the account number and type, to facilitate the electronic payment. If the e-mail address above is blank or is not your current e-mail address, please provide the correct e-mail address in the field below:

Upload Supporting Documentation

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

Select File for Upload:

File Description:

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Attestation

By signing below, I attest that I am the person identified above or I am the legally authorized personal representative, guardian, or trustee of the person identified above, and that, to the best of my knowledge, the information on this Claim Form is true and correct:

Signature *

Date

Venerus, et. al. v. Avis Budget, et al

Case No. 6:13-cv-921-CEM-GJK

United States District Court Middle District of Florida Orlando Division

Claim Form

Your Deficiency Response has been submitted successfully.

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
Name
Primary Address
Primary Address continued
City
State
Province
Zip Code
Postal Code
Country
Email Address