Claim Form

Contact Information

Please provide contact information below. You must notify the Settlement Administrator if your contact information changes after you submit this Claim Form.

First Name

Last Name

Address 1

Address 2

City

State

Zip Code

Phone

Email

Purchase Information

Class Members may claim $2.00 per carton of Alderfer non-organic eggs. Depending on if you have proof of purchase. Class Members can either claim up to two (2) cartons without proof of purchase, or as many cartons as their documentation shows.

What type of claim do you wish to file for?*

I would like you to claim for payment based on proof of purchaseI would like to claim for payment without proof of purchase

Which products did you buy?* (Select as many that apply)

Medium, Grade A Brown Eggs, Cage Free (plastic carton)Large, Grade A Eggs, Cage Free, 18-count (plastic carton) Large, Grade A Eggs, Natural, Cage Free (paper carton)Large, Grade A Brown Eggs, Certified Humane, Cage Free (plastic carton)Large, Grade A Brown Eggs, Certified Humane, Cage Free, 6-count (plastic carton)Large, Grade A Brown Eggs, Certified Humane, Natural, Cage Free (paper carton)Large, Grade A White Eggs, Omega, Cage Free (paper carton)Large, Grade A White Eggs, Omega, Cage Free (plastic carton)Large, Grown Eggs, Cage Free (paper carton)Extra Large, Grade A Brown Eggs, Certified Humane, Natural, Cage Free (paper carton)Jumbo, Grade A Brown Eggs, Cage Free (plastic carton)

Please list the retailer(s) where you purchased the eggs. Include the location (city and state), and the approximate date or your purchase. You must provide at least one (1) retailer.

Name of Retailer*	Location (City, State)*	Approximate Date of Purchase*
		12/1/2020 - Today
		12/1/2020 - Today
		12/1/2020 - Today
		12/1/2020 - Today
		12/1/2020 - Today

Note: Please provide the Retailer(s) you made the most purchase(s) at.

Payment Election

Please select one of the following payment options, which will be used should you be eligible to receive a settlement payment. Please remember that the Court in charge of this case still has to decide whether to approve the Settlement. Payments will be made once the Court approves the Settlement and after appeals are resolved. Please be patient.

IMPORTANT NOTES:

For E-Master Card, PayPal, Venmo, and Zelle payments, if there are any discrepancies, if the account is no longer active, or if the Settlement Administrator deems that payment cannot or should not be made based on the provided information, the Claims Administrator will either contact you for clarification or be authorized to default to a Check payment.
If domestic or international payment limits apply to your payment, you may receive more than one transmission or you may default to a Check payment.
Venmo and Zelle payments cannot be made to accounts outside of the United States.
Payments by Check will be made out to the Name on this Claim Form and mailed to the address on this Claim Form.

Attestation & Signature

By signing below, I swear and affirm that the information provided in this Claim Form, and any supporting documentation provided is true and correct to the best of my knowledge. I understand that my claim is subject to verification and that I may be asked to provide supplemental information by the Settlement Administrator before my claim is considered complete and valid.

Signature

Date