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 APRIL 12, 2019.
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 Notice & Claims Administrator of any changes to your contact information after the submission of your Claim Form.
(Claims of more than 30 products require submission of actual purchase receipts in support of your Claim.)
Your claim reflects more than 30 products purchased. Per the terms of the settlement agreement you must provide actual purchase receipts for additional purchases to the satisfaction of the Claims Administrator.
Your file(s) will be uploaded once you click "Submit" at the end of this form
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 furnish additional information to support this claim if required to do so.
(Type your name here to electronically sign your Claim Form)