Holve v. McCormick & Company, Inc.

Case No. 6:16-cv-06702

UNITED STATES DISTRICT COURT FOR THE WESTERN DISTRICT OF NEW YORK

Please click the link for CLAIM FORM INSTRUCTIONS

  1. You may submit your Claim Form online on this page or by U.S. Mail to the following address: Holve v. McCormick Settlement, c/o Settlement Administrator, 1650 Arch Street, Suite 2210, Philadelphia, PA 19103. Please make sure to include the completed and signed Claim Form and all supporting materials in one envelope.
  2. You must complete the entire Claim Form. Please type or write your responses legibly.
  3. Please keep a copy of your Claim Form and any supporting materials you submit. Do not submit your only copy of the supporting documents. Materials submitted will not be returned. Copies of documentation submitted in support of your Claim should be clear and legible.
  4. If your Claim Form is incomplete or missing information, the Settlement Administrator may contact you for additional information. If you do not respond, the Settlement Administrator will be unable to process your claim, and you will waive your right to receive money under the Settlement.
  5. If you have any questions, please contact the Settlement Administrator by email at info@McCormickSettlement.com or by mail at the address listed above.
  6. You must notify the Settlement Administrator if your address changes. If you do not, you may not receive your payment.
  7. DEADLINE -- Your claim must be submitted online no later than 90 days after Final Approval. Claim Forms submitted by mail must be postmarked no later than 90 days after Final Approval.
I. YOUR CONTACT INFORMATION AND MAILING ADDRESS

Provide your name and contact information below. You must notify the Settlement Administrator if your contact information changes after you submit this form.

* Required Fields
II. PURCHASE INFORMATION OR DOCUMENTATION

Please select one of the following options. If you do not have proof of purchase, complete the chart that will appear when you select the “I do not have proof of my Product purchase” option below.

The claimed purchases must be direct retail (in-store or online) purchases made by you and the purchases were not made for purposes of resale or commercial use.

Final payment amounts may be proportionately increased or decreased on a pro rata basis depending on the total amount of timely, valid, and approved Claim Forms.

Product Name Approximate Date of Purchase (MM/YY) Name of Retail Store Product was Purchased Store Location (State)
1.

Product Name 1

Approximate Date of Purchase (MM/YY) 1

Name of Retail Store Product was Purchased 1

Store Location (State) 1
2.

Product Name 2

Approximate Date of Purchase (MM/YY) 2

Name of Retail Store Product was Purchased 2

Store Location (State) 2
3.

Product Name 3

Approximate Date of Purchase (MM/YY) 3

Name of Retail Store Product was Purchased 3

Store Location (State) 3
4.

Product Name 4

Approximate Date of Purchase (MM/YY) 4

Name of Retail Store Product was Purchased 4

Store Location (State) 4
5.

Product Name 5

Approximate Date of Purchase (MM/YY) 5

Name of Retail Store Product was Purchased 5

Store Location (State) 5
6.

Product Name 6

Approximate Date of Purchase (MM/YY) 6

Name of Retail Store Product was Purchased 6

Store Location (State) 6

7.

Product Name 7

Approximate Date of Purchase (MM/YY) 7

Name of Retail Store Product was Purchased 7

Store Location (State) 7
8.

Product Name 8

Approximate Date of Purchase (MM/YY) 8

Name of Retail Store Product was Purchased 8

Store Location (State) 8
9.

Product Name 9

Approximate Date of Purchase (MM/YY) 9

Name of Retail Store Product was Purchased 9

Store Location (State) 9
10.

Product Name 10

Approximate Date of Purchase (MM/YY) 10

Name of Retail Store Product was Purchased 10

Store Location (State) 10
11.

Product Name 11

Approximate Date of Purchase (MM/YY) 11

Name of Retail Store Product was Purchased 11

Store Location (State) 11
12.

Product Name 12

Approximate Date of Purchase (MM/YY) 12

Name of Retail Store Product was Purchased 12

Store Location (State) 12
13.

Product Name 13

Approximate Date of Purchase (MM/YY) 13

Name of Retail Store Product was Purchased 13

Store Location (State) 13
14.

Product Name 14

Approximate Date of Purchase (MM/YY) 14

Name of Retail Store Product was Purchased 14

Store Location (State) 14
15.

Product Name 15

Approximate Date of Purchase (MM/YY) 15

Name of Retail Store Product was Purchased 15

Store Location (State) 15

Proof of Purchase

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

File List: No Files Selected

    III. PAYMENT SELECTION

    Please select one of the following payment options:

    IV. VERIFICATION AND ATTESTATION

    By signing below and submitting this Claim Form, I hereby affirm that I am the person identified above and the information provided in this Claim Form, including supporting documentation is true and correct, and that nobody has submitted another claim on my behalf in connection with this Settlement.

    Please add at least one Product to the table above.

    Your Claim Form has been submitted successfully.

    HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: info@McCormickSettlement.com.

    Please print this page for your records.

    Your Claim Details

    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
    CLAIM INFORMATION
    First Name
    Last Name
    Street Address
    City
    State
    Zip Code
    Email Address
    Telephone Number
    Signature
    Date

    If you have any questions regarding your Claim, please provide the Submitted Claim ID listed above and email us at info@McCormickSettlement.com

    Click here to edit your Claim.