POCKET HOSE CLAIM FORM

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Inocencio, et al. v. Telebrands Corporation, Docket No. L-4378-16

SUPERIOR COURT OF NEW JERSEY BERGEN COUNTY

If you purchased Pocket Top Brass II, Pocket Hose Top Brass, Pocket Hose Dura Rib II, Pocket Hose Dura Rib, Pocket Hose Ultra, or Pocket Hose (the “Class Products”), to be eligible to participate in the benefits of the proposed settlement in Inocencio, et al. v. Telebrands Corporation, you must fill out a claim form completely and either (i) mail it to the Settlement Administrator, or (ii) submit it online through this online claim form. Claim forms must be postmarked or electronically filed no later than February 10, 2017. If you provide incomplete or inaccurate information, your claim may be denied.

Please read the full notice of this settlement carefully before filling out this Claim Form. Click here to view.

PART A: CLAIMANT INFORMATION

Provide your name and additional information below. It is your responsibility to notify the Claims Administrator of any changes to your contact information after the submission of your Claim Form.

PART B: PURCHASE INFORMATION
  • To be eligible for a payment you must not have previously received a refund for your purchase of Class Product.
  • To qualify for a cash award, you must have purchased one or more of the following Telebrands’ Products from January 31, 2014 through November 4, 2016: (i) “Pocket Top Brass II”, (ii) “Pocket Hose Top Brass”, (iii) “Pocket Hose Dura Rib II”, (iv) “Pocket Hose Dura Rib”, (v) “Pocket Hose Ultra”, and (vi) the “Pocket Hose” products (the “Class Products”).
  • You may make a claim for one of the following:
    • For a full refund of the actual purchase price, Settlement Class Members who return a Class Product to the Settlement Administrator, will receive a full refund between $13.00 and $50.00 per household (depending on which Class Product you purchased) up to the total amount of units purchased that are returned with Proof of Purchase. Free shipping will be provided to return the Class Product(s).
    • For Settlement Class Members who provide a copy of the receipt or a retail rewards submission memorializing the purchase of the Class Products or your purchases appear in Defendant’s records (“Proof of Purchase”), but who do not return the Class Products, you will receive a refund between $7 and $25 per household (depending on which Class Product you purchased) for each Class Product purchased up to the total amount of units purchased that are returned with Proof of Purchase.
    • For those Settlement Class Members who neither return the Class Products nor provide a valid receipt nor a retail rewards submission memorializing the purchase of the Class Products nor do your purchases appear in Defendant’s records, but who complete this Claim Form under penalty of perjury, you will receive a total refund per household of $7.00.
  • Please fill out this chart identifying the purchase transaction(s) for which you are making a claim:

TOTAL NUMBER OF SUBJECT PRODUCTS

Model Name/Class Length of Class Product Number of Products Purchased Approximate Date of Purchase State of Purchase Place of Purchase(from which retailer) Total Purchase Price (Optional)
Pocket Hose Top Brass II
Pocket Hose Top Brass
Pocket Hose Dura Rib II
Pocket Hose Dura Rib
Pocket Hose Ultra
Pocket Hose
Please choose one of the following:

*Failure to Return the Class Product or include Proof of Purchase for claims will result in the reduction of your claims.
*Submission of false or fraudulent information may result in the claim being rejected in its entirety.

PART C: ATTESTATION UNDER PENALTY OF PERJURY I declare under penalty of perjury under the laws of the United States of America that I purchased the products listed above between January 31, 2014 and November 4, 2016 and that all of the information on this Claim Form is true and correct to the best of my knowledge. I understand that my Claim Form may be subject to audit, verification, and Court review and that I may be required to provide additional information to establish that my claim is valid. I also understand that by submitting this claim, I am releasing all Released Claims, as detailed in the Notice of the Proposed Class Action Settlement.