Thompson v. 1-800 Contacts, Inc.

United States District Court, District of Utah, Central Division | No. 2:16-cv-01183

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CLAIM FORM

You must complete this Claim Form to be considered to receive a payment from the Settlements in Thompson v. 1 800 Contacts, Inc., Vision Direct, Inc., Walgreens Boots Alliance, Inc., Walgreen Co., Arlington Contact Lens Service, Inc., National Vision, Inc., Luxottica of America, Inc. (f/k/a Luxottica Retail North America, Inc.), No. 2:16-cv-01183 (D. Utah). Your claim must be submitted by December 4, 2020.

Section 1: Class Member Information

*First Name		Required
Middle Initial		Required
*Last Name		Required
*Primary Address		Required
Primary Address Continued
*City		Required
*State		Required
*Zip		Required
*Country		Required

*Required

THE DEADLINE TO SUBMIT A CLAIM FORM EXPIRED ON DECEMBER 4, 2020.

Section 2: Purchase Information

Defendant Company Name(s):	Relevant Period:	Total Dollar Amount Of Contact Lenses Purchased Online From Specified Defendant(s) During The Relevant Period:
National Vision, Inc. and Arlington Contact Lens Service, Inc.	March 10, 2010 to September 19, 2017
Luxottica of America Inc., a/k/a LensCrafters, Target Optical and Contacts Direct	December 23, 2013 to July 5, 2019
Vision Direct, Inc., Walgreens Boots Alliance, Inc., and Walgreen Co.	January 1, 2004 to September 12, 2019
1-800 Contacts, Inc.	January 1, 2004 to September 12, 2019

The Total Dollar Amount of Contact Lens Purchased represents the total amount paid for the contact lens purchased online (i.e., through defendants’ website(s) or mobile application), including shipping, handling, and taxes.

At the time of disbursement, you will receive an email at the email address provided above with instructions about how to obtain your settlement payment electronically via Paypal, Venmo or ACH/Direct Deposit. If you prefer a paper check instead, you must contact the Settlement Administrator by calling toll-free at 1-888-506-0436. To process your request, you will need to provide the unique confirmation number associated with your claim, which will be provided in the confirmation email sent after your claim is submitted.

Certification

By signing and submitting this Claim Form, I certify and affirm under penalty of perjury under the laws of the United States of America, that: (i) I have personal knowledge of all of the information I provided in this Claim Form and that such information is true and correct to the best of my knowledge; (ii) I am a member of a Settlement Class because I purchased from one or more of the Defendants during the time period specified above and did not request to be excluded from the Settlement Classes; (iii) I submit to the jurisdiction of the United States District Court for the District of Utah with respect to this claim; and (iv) I agree to furnish additional information and/or documentation regarding this claim that the Settlement Administrator, Co-Lead Class Counsel, or the Court may require.

*Signature		Required
*Date

CPT GROUP, Inc.

50 Corporate Park, Irvine, CA 92606

‍

CONTACT INFORMATION

‍Toll-Free Class Member Support:
1-888-506-0436

‍Case Email:
OnlineContactLensSettlement@cptgroup.com

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