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Jacobo, et al., v. Ross Stores, Inc. Settlement

2:15-cv-04701-MWF-AGRx | Appellate Case No. 17-56241; U.S.D.C.

United States District Court for the Central District of California


Claim Form

 

If you purchased one or more items from a Ross store between June 20, 2011 and the present, with a Ross price tag that included a “Compare At” price, and you have not received a refund or credit for all of your purchases, you may be eligible to receive benefits from a Settlement with Ross.  You need to submit this Claim Form if you want to receive a Merchandise Certificate that can be used to purchase items at a Ross store.  The Merchandise Certificate can be redeemed for cash in an amount equal to 75% of the Merchandise Certificate at the time of its issuance for up to one year after issuance by returning the Merchandise Certificate unused to the Claims Administrator.  The deadline to file a claim is May 31, 2019.

The amount of the Merchandise Certificate will be determined based on the number of people who submit a claim, as detailed in the Settlement Agreement and in the Notice of Class Action Settlement.  Additional information regarding the formula and the Settlement can be found at www.rosspricingsettlement.com.

To claim a Merchandise Certificate you may submit the Claim Form online at www.rosspricingsettlement.com., or if you are unable to submit online, you may send the Claim Form by U.S. Mail.  If submitting by U.S. Mail, print and complete this Claim Form and mail it to the following address postmarked on or before May 31, 2019.

Ross Claims Administrator
c/o CPT Group, Inc.
50 Corporate Park

Irvine, CA 92606

Please Complete Each Section Below In The Space Provided

SECTION I: CONTACT INFORMATION

*REQUIRED




SECTION II: AWARD DELIVERY PROCESS

You will receive a store credit delivered through the U.S. Mail.

 

SECTION III: AFFIRMATION

I hereby affirm, under penalty of perjury, that I purchased one or more items from a Ross store between June 20, 2011 and the present, with a Ross price tag that included a “Compare At” price, and I have not received a refund or credit for all of my purchase.

The information I have provided in this Claim Form is true and correct to the best of my knowledge and this is the only Ross Claim Form that I have submitted.  I further understand, acknowledge, and agree that I am eligible to receive only ONE payment from this Settlement based on all my purchases from Ross.  I further understand, acknowledge, and agree that the amount I will receive shall be calculated according to the terms of the Settlement Agreement and subject to the terms of the Settlement Agreement, including the release of claims.

 

 
 

NOTE: By signing and submitting this form, you agree to including and claiming yourself to be involved as a Class Member in the above case.