PROOF OF CLAIM

Personal Info
Physical Address
Mailing Address
Machine Claims
Machine Claim: ${ this.selectedGame }
$
$

Background Info

Name: ${ claim.first_name } ${claim.last_name}
Email: ${ claim.email }
Phone: ${ claim.phone }
Physical Address: ${ claim.physical_address_street }, ${ claim.physical_address_suite }
${ claim.physical_address_city }, ${ claim.physical_address_state }, ${ claim.physical_address_zip }
${ claim.physical_address_country }
Mailing Address: ${ claim.mailing_address_street }, ${ claim.mailing_address_suite }
${ claim.mailing_address_city }, ${ claim.mailing_address_state }, ${ claim.mailing_address_zip }
${ claim.mailing_address_country }
Are you a plaintiff or claimant? ${ claim.plaintiff_or_claimant }

Machine Claim: ${ key }

Do you have a copy of a signed contract with Zidware or Popadiuk? ${ machine.signed_contract }
Amount Paid: $${ machine.amount_paid }
Do you have any written correspondence to or from Zidware or Popadiuk to support your claim? ${ machine.supporting_docs }
Amount Owed: $${ machine.amount_owed }
Have you conveyed, sold your rights to, or promised to convey or sell right to any other person or entity? ${ machine.machine_conveyed_or_sold }
Conveyance or sale details: ${ machine.machine_conveyed_or_sold_details }

Claim Submission Complete

You will receive an email shortly providing you with your claim number(s) and additional instructions for submitting the required supporting documentation. If you do not receive an email within 24 hours, please contact us at claims@deeproottech.com to request assistance.

Due to the volume of requests, please allow up to 5 business days for responses (as to claims filed or other correspondence).

Back to deeproot Tech Back to Zidware Claim Page

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