Payment Request Form

If you were an au pair on a J-1 visa in the United States between Jan. 1, 2009, and October 28, 2018, you could get a payment from a settlement.

Payment Request Form

If you were issued a settlement check for the Au Pair Class Action but did not receive it or were unable to cash it, and would like to request payment by wire transfer, please provide the information requested in the form below.

Please note that this is a secure online form. Any information you submit will be stored securely and will only be used for the purpose of issuing payments to class members who have not been able to receive their settlement benefit. If you have any questions about the form or the information being requested, please contact the Administrator via email at info@aupairclassaction.com.

IMPORTANT: When filling out the form, please make sure the details you provide are correct and complete. If you provide incorrect or incomplete wire instructions and the wire cannot be completed, you will be responsible if the funds are not successfully transferred or any fees are incurred.

Identification

To help us confirm your identity, please provide the List ID contained in the notice you received and the email address to which the notice was sent.

List ID *

Email Address *

Bank Information

Provide information about the bank where your account is held.

Bank Name *

Bank Address *

Bank City *

Bank State *

Bank Zip *

Bank Country *

If your bank uses an intermediary bank for wire transfers, check the box below and enter the intermediary bank’s information in the “Intermediary Bank” section.

Does your bank use an intermediary bank for wire transfers?

Account Information

Provide information about your account. For the name and address, this should be the name and address you have on record with the bank, which may be different from your current name and address. If you do not know your routing number, SWIFT/BIC, or IBAN, this may be listed on your bank statements, or your bank will be able to provide this information.

Account No. *

ABA/Routing No.

SWIFT/BIC *

IBAN/CLABE/BSB

Accountholder Name *

Accountholder Address *

Accountholder City *

Accountholder State *

Accountholder Zip *

Accountholder Country *

Intermediary Information

Intermediary Name *

Intermediary Address *

Intermediary City *

Intermediary State *

Intermediary Zip *

Intermediary Country *

Intermediary ABA/Routing No.

Intermediary SWIFT/BIC

Intermediary Account No. *

Please review the information you have entered before submitting it. If you are satisfied that the form has been filled out correctly, click on the button below to submit your request.

If you have read the information available on this website but still have questions, you can contact the class administrator using one of the following methods:

By Mail

Beltran v. InterExchange
c/o JND Legal Administration
P.O. Box 91345
Seattle, WA 98111

By Email
info@aupairclassaction.com

By Phone
1-844-859-6769

AU PAIR CLASS ACTION