Bauman v. Foodstate

Claim Form

CLAIMANT INFORMATION

Purchases

You may claim up to 4 bottles.

Bottle 1

Bottle 2

Bottle 3

Bottle 4

UPLOAD SUPPORTING DOCUMENTATION (IF ANY)

Click the "Browse" or “Choose File” button and select the relevant file from your computer. The selected files will be uploaded when the "Agree and Submit" button is clicked.

Files may be uploaded in the following formats: .pdf,.jpg,.jpeg,.tif,.tiff,.gif,.png

You may upload up to 10 files.

A single file cannot be larger than 10 MB.

CERTIFICATION

Required