Senco Brands Settlement Administrator

P.O. Box 43034

Providence, RI 02940-3034

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Craftwood Lumber Company v. Senco Brands, Inc. Must Be Received
No Later Than
UNITED STATES DISTRICT COURT
June 6, 2017
NORTHERN DISTRICT OF ILLINOIS
Case No. 14-CV-06866

CLASS MEMBER INFORMATION FORM

Craftwood Lumber Company v. Senco Brands, Inc.

1. FAX NUMBER:

**No later than June 6, 2017, please provide the name and address of the subscriber of the fax telephone number that was sent a
fax by SBI on or after September 5, 2010.

Fax Number:

Subscriber

Street Address

Continuation of Street Address

City State Zip Code

2. CERTIFICATION [REQUIRED]:

I certify under penalty of perjury that (a) the information I provided on this form is true and correct; and (b) in the case of a business entity
named above, that I am an authorized representative of such business entity to provide the information in the form.

Signature:

Print Name:

Title/Position/Company:

Telephone Number (in case we need to contact you):

Email Address (in case we need to contact you):

If you have provided any corrected information on this form you must sign and complete the certification. This form must be received by
June 6, 2017:

(a) By fax to: 1-877-839-3322 OR

(b) By mail to: Senco Brands Settlement Administrator, P.O. Box 43034, Providence, RI 02940-3034

Questions? Call 1-866-596-9826 or visit www.sbisettlement.com

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