Biegel, et al. v. Blue Diamond Growers

Case No. 7:20-cv-03032-CS

United States District Court for the Southern District of New York

CLAIM FORM INSTRUCTIONS

  1. You may submit your Claim Form online on this page or by U.S. Mail to the following address: Blue Diamond Growers Settlement, c/o Claims 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.
  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 Claims Administrator may contact you for additional information. If you do not respond, the Claims 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 Claims Administrator by email at Questions@AlmondBreezeSettlement.com or by mail at the address listed above.
  6. Each Household is limited to and may only submit a single Claim Form.
  7. You must notify the Claims Administrator if your address changes. If you do not, you may not receive your payment.
  8. DEADLINE -- Your claim must be submitted online by November 23, 2021. Claim Forms submitted by mail must be delivered to the Claims Administrator no later than November 23, 2021. Click here to download a paper Claim Form.
I. YOUR CONTACT INFORMATION AND MAILING ADDRESS

Provide your name and contact information below. You must notify the Claims 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.

1 Payment Amounts will be reduced on a pro rata basis (equally proportioned) if the total amount of money claimed with proof of purchase is more than $1,250,000.

2 Payment amounts will be reduced on a pro rata basis (equally proportioned) if the total amount of money claimed without proof of purchase is more than $750,000.

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

Product Name 1

Approximate Date of Purchase (MM/DD/YY) 1

Approximate Price 1

Name of Retail Store Product was Purchased 1

Store Location 1

2.

Product Name 2

Approximate Date of Purchase (MM/DD/YY) 2

Approximate Price 2

Name of Retail Store Product was Purchased 2

Store Location 2

3.

Product Name 3

Approximate Date of Purchase (MM/DD/YY) 3

Approximate Price 3

Name of Retail Store Product was Purchased 3

Store Location 3

4.

Product Name 4

Approximate Date of Purchase (MM/DD/YY) 4

Approximate Price 4

Name of Retail Store Product was Purchased 4

Store Location 4

5.

Product Name 5

Approximate Date of Purchase (MM/DD/YY) 5

Approximate Price 5

Name of Retail Store Product was Purchased 5

Store Location 5

6.

Product Name 6

Approximate Date of Purchase (MM/DD/YY) 6

Approximate Price 6

Name of Retail Store Product was Purchased 6

Store Location 6

7.

Product Name 7

Approximate Date of Purchase (MM/DD/YY) 7

Approximate Price 7

Name of Retail Store Product was Purchased 7

Store Location 7

8.

Product Name 8

Approximate Date of Purchase (MM/DD/YY) 8

Approximate Price 8

Name of Retail Store Product was Purchased 8

Store Location 8

9.

Product Name 9

Approximate Date of Purchase (MM/DD/YY) 9

Approximate Price 9

Name of Retail Store Product was Purchased 9

Store Location 9

10.

Product Name 10

Approximate Date of Purchase (MM/DD/YY) 10

Approximate Price 10

Name of Retail Store Product was Purchased 10

Store Location 10

Proof of Purchase

Accepted file types are: DOCX, DOC, 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 UNDER PENALTY OF PERJURY

    By signing below and submitting this Claim Form, I hereby swear under penalty of perjury 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 from my household has submitted another claim 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 send your documents with your Submitted Claim ID to the Settlement Administrator by email to: Questions@AlmondBreezeSettlement.com.

    Please print this page for your records.

    Your Claim Details

    Submitted Claim ID:
    Confirmation Code:
    CLAIM INFORMATION
    First Name
    Last Name
    Street Address
    City
    State
    Zip Code
    Email Address
    Signature
    Date

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