You must accurately complete all required portions of this Claim Form and submit the Claim Form under penalty of perjury.
YOU MUST SUBMIT YOUR CLAIM FORM NO LATER THAN JANUARY 6, 2020.
Provide your name and contact information below.
This information will be used to deliver your Settlement Benefit and communicate with you if any problems arise with your claim. It is your responsibility to notify the Settlement Administrator of any changes to your contact information after the submission of your Claim Form.
I declare that I believe that, during the period of time between May 24, 2010 and May 10, 2019,
I purchased in-store or online from a Gap Outlet, Gap Factory Store or a Banana Republic Factory
Store in the United States an item or items where a higher reference price was displayed, and that
my purchases during this period totaled (select one) :*
Your claim reflects you purchased $90 or more of products (exclusive of returns) from Gap Outlet, Gap Factory Store or a Banana Republic Factory Store between May 24, 2010 and May 10, 2019. Per the terms of the settlement agreement you are required to provide with this Claim Form proof of qualifying purchases. Acceptable proofs of your purchases include (a) receipt(s) clearly showing the date of purchase(s) and the total of the purchase(s), or (b) a credit or debit card transaction record clearly showing the date of purchase(s) and the total of the purchase(s). The proofs of purchase must include sufficient information to allow Gap to verify the purchase(s).
Please choose any one of the following options :*
Your file(s) will be uploaded once you click "Submit" at the end of this form
Please confirm the email address to which you would like the Purchase Certificate(s) delivered.
I have received notice of the class action Settlement in this case and I am a class member as described in the notice. I agree to release all the claims, known and unknown, stated in Section 2.9 of the Settlement Agreement.
I submit to the jurisdiction of the Superior Court of the State of California, County of San Francisco with regard to my claim and for purposes of enforcing the release of claims stated in the Settlement Agreement. I am aware that I can obtain a copy of the full notice and Settlement Agreement at www.GFPricingClassSettlement.com or by writing the Claims Administrator at the email address info@GFPricingClassSettlement.com
or the postal address GF Pricing Settlement Administrator, PO Box 60247, 1500 John F. Kennedy Blvd, Suite 31, Philadelphia, PA 19102. I agree to furnish additional information to support this claim if required to do so.
(Type your name here to electronically sign your Claim Form)