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Move-Up Opt-Out Notice

I am writing to provide notice that I am choosing to opt-out of the Class Action Waiver contained in the following agreement(s): [check the applicable box(es)]:

the MoveUP User Agreement, located at [www.moveuplynchburg.org/move-up-user_agreement.html] (the “MoveUP User Agreement”); and/or
the MoveUP Driver Agreement, located at [www.moveuplynchburg.org/move-up-driver_agreement.html] (the “MoveUP Driver Agreement”).

My Name:

My Address:
My Phone Number(s) associated with my MoveUP User Account and/or MoveUP Driver Account, as applicable:
My E-mail Address(es) associated with my MoveUP User Account and/or MoveUP Driver Account, as applicable:
Signature:
Date:

Please mail this completed form to the following address:
Unified Potential, Inc.
ATTN: Opt-Out Notice Processing
144 Beacon Hill Place
Lynchburg, VA 24503

This MoveUP Opt-out Notice must be postmarked no later than sixty (60) days after the date you created your MoveUP User Account or MoveUP Driver Account, as applicable. It is your responsibility to mail the Opt-out Notice by the applicable deadline and to retain proof of mailing and delivery.

DONATIONS

Your tax-deductible donations will help fund transportation solutions in Lynchburg. All of the funds will be applied to transportation resources through MoveUp.

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