Registration Form

If you are a consumer who paid funds to American Plumbing and Septic Service, LLC or American Plumbing and Septic Service, LLC d/b/a American Drain Cleaning & Plumbing Service, please provide your contact information below.

Please note: this is not a claim form.  It simply provides contact information.

 

First Name *

Last Name *

Home Address *

City *

State/Province *

Zip/Postal Code *

Telephone Number *

(Including Country Code and Area Code As applicable)

Mobile Phone

(Including Country Code and Area Code As applicable)

Primary Email *

Are you a Consumer? *

YesNo
If so, how much did you pay for the services and what was the method of payment?

Are you an Employee?

YesNo
If so, when was your start date; what was your role; and how much, if anything, are you currently owed?

Comments

Are you represented by an attorney?

YesNo