Consent Agreement Form

    FLSA ACTION AGAINST GREENWAY HOME SERVICES, LLC, GREENWAY HOME SERVICES OF NASHVILLE, LLC, WHIT GREENWAY, WHITNEY GREENWAY, AND DEVIN WILLIAMS

    CONSENT FORM

    Plaintiff Consent Form: By my signature below, I hereby authorize the filing and prosecution of a Fair Labor Standards Act action in my name and on my behalf by the named Plaintiff/Claimant, and designate him as my agent to make decisions on my behalf concerning the case, the method and manner of conducting this litigation, the entering of an agreement with Plaintiff/Claimant's Counsel concerning attorneys' fees and costs, to file a proof of claim on my behalf in the event Defendants/Respondents file for bankruptcy protection under Chapters 7 or 11 of the Bankruptcy Act, to negotiate and to take any other action necessary to present or preserve my wage and hour claim against Defendants/Respondents Greenway Home Services, LLC, Greenway Home Services of Nashville, LLC, Whit Greenway, Whitney Greenway, and Devin Williams, and their successors, affiliates, owners, and/or principals.

    Name (Required)
    Date (Required)

    CONTACT INFORMATION

    THE FOLLOWING INFORMATION IS NOT FOR FILING, BUT FOR INFORMATIONAL USE BY COUNSEL FOR CLAIMANT(S) ONLY

    Last 4 Digits of Social Security Number (Required)
    Telephone Number (Required)
    Cell Phone Number
    E-mail Address(Required)
    Address (Required)