F O R O FFI C I A L U S E O N LY In re M3Power Razor System Marketing & Sales Practices Litigation Civil Action No. 05-11177 (Lead Case) United States District Court for the District of Massachusetts
C L AIM FORM LIMITED TO ONE PER PERSON, AND THREE PER HOUSEHOLD MUST BE POSTMARKED NO LATER THAN MAY 2, 2011 and SENT TO EITHER: M3POWER SETTLEMENT P.O. BOX 2302 FARIBAULT, MN 55021-9002
M3POWER SETTLEMENT P.O. BOX 1051 FORT ERIE, ON L2A 6C7
A . NAME AND ADDRE S S: First Name:
Zip Code/Postal Code:
Mailing Address: City/Town:
B. C ER T IFIC AT ION: BY SIGNING BELOW, I CERTIFY THAT I LIVE IN THE UNITED STATES OR CANADA, AND THAT I ACQUIRED FOR USE AND NOT RESALE AN M3POWER RAZOR (CHECK ONE):
IN THE UNITED STATES BETWEEN MAY 1, 2004 AND SEPTEMBER 30, 2005, OR
IN CANADA BETWEEN MAY 1, 2004 AND OCTOBER 31, 2005.
I ALSO HEREBY CERTIFY THAT I AM NOT SUBMITTING ANY OTHER CLAIM FOR A REFUND, REBATE, OR REPLACEMENT RAZOR.
C . C H O IC E BE T WEEN REFUND OR REBAT E S OR REPL AC EMEN T R A ZOR: CHOOSE EITHER THE REFUND OPTION, OR THE REBATES OPTION OR THE REPLACEMENT RAZOR OPTION. YOU MAY NOT CHOOSE MORE THAN ONE OPTION. REFUND OPTION. I am enclosing the M3Power Razor that I purchased or otherwise acquired.
REBATES OPTION. YES
I am claiming:
(required for this option)
REPLACEMENT RAZOR OPTION. ONE REBATE TWO REBATES
I am electing to receive a new Gillette manual men’s razor.
The refund is $13 U.S. or $16.25 Canadian.
The rebates are $5 U.S. each, or the equivalent in Canadian dollars, on purchase(s) M3Power blades and/or Fusion or Fusion OPTIONAL: To claim a higher refund, you of MUST ALSO submit a receipt for the M3Power ProGlide razors (manual or battery powered). Razor showing that the price paid was more You MUST enclose the UPC code or a than $13 US or $16.25 Canadian. receipt for each purchase to claim a rebate. You cannot receive two rebates on the purchase of a single item. See the Notice of Class Action Settlement for details, available at www.m3powersettlement.com or by calling 1-877-506-4030.
D. I DEC L ARE UNDER PENALT IE S OF PER JURY T HAT T HE ABOVE I S T RUE AND CO RREC T. Signature: