Submit a Deficiency Response | FabFitFun Settlement

SETTLEMENT CLAIM FORM

Please click the link for GENERAL INSTRUCTIONS

1. CLASS MEMBER INFORMATION (REQUIRED)

First Name *

Last Name *

Street Address *

Street Address 2

Country *

City *

State *

Zip Code *

Phone

Email *

I attest under penalty of perjury that I purchased a new subscription from FabFitFun’s website during the time period of April 26, 2020 to May 14, 2020 or May 22, 2020 to August 3, 2020:

Approximate date of purchase

Last 4 digits of credit or debit card used (if applicable)

(Check if Apple Pay or PayPal used for purchase). I attest under penalty of perjury that I paid for my purchase with Apple Pay or PayPal.

(Check if card is no longer available). I attest under penalty of perjury that I no longer have the debit or credit card used and do not know or have any records showing the last 4 digits of this card.

2. PAYMENT ELIGIBILITY INFORMATION (REQUIRED)

To prepare for this section of the Claim Form, please review the Class Notice and Sections 2.1 through 2.4 of the Settlement Agreement for more information on the types of awards available and rules for receiving an award.

Settlement Class Members may receive only one of the following types of awards: (1) Basic Award; or (2) Reimbursement Award. Which type of award are you making a claim for (check one)?

Basic Award (go to Section 6)

Reimbursement Award (go to Section 3)

4. ADDITIONAL INFORMATION REQUIRED FROM SETTLEMENT CLASS MEMBERS SEEKING REIMBURSEMENT FOR OUT-OF-POCKET EXPENSES IN CONNECTION WITH A REIMBURSEMENT AWARD.

Are you seeking Reimbursement of Out-of-Pocket Expenses?

Yes

I attest under penalty of perjury that I am making a claim for a Reimbursement Award, and that I incurred the following Out-of-Pocket Expenses as a result of one or more unauthorized charges between April 26, 2020 and January 30, 2021 on a credit or debit card I used to make a purchase from the FabFitFun website.

I believe in good faith that such unauthorized charges were more likely than not the result of the security incident that affected FabFitFun’s website that was first disclosed to customers by FabFitFun in September 2020.

Check all that apply, stating the total amount you are claiming for each category and attaching documentation of the charges as described below. Round total amounts to the nearest dollar.

Unreimbursed payment card fees or bank fees

Total amount claimed for this category: $

Examples: Overdraft fees, over-limit fees, late fees, charges due to insufficient funds or interest, card reissuance fees.

Required: A copy of a bank or credit card statement or other proof of claimed fees or charges (you may redact unrelated transactions).

Cell, internet or text charges

Total amount claimed for this category: $

Examples: Long distance or cell phone charges (if charged by the minute), or data charges (if charged based on the amount of data used).

Required: A copy of the bill from your telephone company, cell phone company, or internet service provider showing the claimed charges.

Unreimbursed costs of obtaining credit reports, credit freezes, or credit monitoring or identity theft protection services (up to two years of coverage)

Total amount claimed for this category: $

Examples: The cost of purchasing a credit report or placing a credit freeze.

Required: A copy of a receipt of other proof of purchase for each credit report or credit freeze purchased or placed.

Postage costs

Total amount claimed for this category: $

Examples: Postage for correspondence with your bank or credit card company about unauthorized charges. The cost of submitting this form is not included.

Required: A copy of any receipt or proof of purchase for all postage costs claimed showing date, amount and vendor.

6. CERTIFICATION

I declare under penalty of perjury under the laws of the United States and the state where this Claim Form is signed that the information I have supplied in this Claim Form is true and correct to the best of my recollection, and that this form was executed on the date set forth below.

I understand that all information provided on this Claim Form is subject to verification and that I may be asked to provide supplemental information by the Claims Administrator or Claims Referee before my claim will be considered complete and valid.

Signature *

Date

Gaston, et al. v. FabFitFun, Inc.

Case No. 2:20-cv-09534-RGK-E

United States District Court, Central District of California

SETTLEMENT CLAIM FORM

Please click the link for GENERAL INSTRUCTIONS

Your Claim Form has been submitted successfully.

Submitted Claim ID:
Confirmation Code:
You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please print this page for your records.
CLAIM INFORMATION
First Name
MI
Last Name
Street Address
Street Address 2
City
State
Province
Zip Code
Postal Code
Country
Phone
Email