Claim Form

In order to prepare the Claim Form so that you can download and print it with the bar code needed for us to process it, please fill out the form below and click Submit. This is a large file and might take a few minutes.

Once your personalized Claim Form has been generated and you have printed it out, you must mail the completed form to the address listed on the printed Claim Form.

Acrobat Reader is Required to download the Claim Form which will be in PDF format. You may already have the Adobe Acrobat Reader on your computer or on disks that came with your computer. If you do, you won't need to download Adobe Acrobat.

If you do not have Acrobat, please click here to download the Free Adobe Acrobat Reader.

Contact Information
First Name:
Last Name:
Country:
Enter Your Country:
Address:
City:
State:
Zip:

Important Dates
DateDeadline
December 10, 2012 Exclusion Deadline
(Postmarked)
December 10, 2012 Objection Deadline
(Filed)
December 10, 2012 Claim Form Deadline
(Submitted or Postmarked)
January 25, 2013
at 1:30 p.m.		 Fairness Hearing

Your Options

  • To participate in the Settlement, submit a Claim Form
  • To find out details regarding how to exclude yourself from or object to the Settlement, please consult the Notice