If you received a personalized notice in the mail or via email with a Notice Id and Confirmation Code, please enter the codes you were provided below. Please remember to enter the full Notice ID exactly as it appears on your personalized notice, (i.e. 12345678). Notice Id Confirmation Code OR If you did not receive a personalized notice in the mail or via email, click below to complete a Claim Form. The deadline for submitting this proof of claim form is February 27, 2018 I. Provide Your Contact Information: First Name * Last Name * Street Address * City * Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State * Zip Code * Email Address * Phone Number * * Required Fields V. Purchase Receipts 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. Select File for Upload: File Description: File List: No Files Selected VI. Fill Out and Sign the Following Attestation: I declare under penalty of perjury under the laws of the United States that I am a Class Member (as defined in the Class Notice), and that the information in this Claim Form and any documentation attached to it are true and correct to the best of my knowledge. If I did not provide required documents, it is because I do not have them. Signature * Date