Mueller Settlement

MUELLER SETTLEMENT CLAIM FORM

Name: *

Street Address: *

Country: *

City: *

State: *

Zip: *

Mobile Phone Number : *

Select Day Of Week For Filing: *

Email: *

Confirm Email Address: *

Please ensure you provide a current, valid email address and mobile phone number with your Claim submission. If the email address or mobile phone number you include with your submission becomes invalid for any reason, it is your responsibility to provide the Settlement Administrator with a current, valid email address and mobile phone number for payment.

You have two options for filing your claim. If you wish to receive a cash or electronic payment you may choose Option A. If you wish to receive a voucher usable at muellerdirect.com, you may choose Option B. Please select which option you wish to receive below: (Please select only one option below)

Option A , you can receive $7.50 per Mueller Branded Product, up to $15.00 depending on the number of products you purchased. The actual amount you may receive may be higher or lower than the above depending on the number of claimants who select this option.

Option B , you can receive $15.00 per Mueller Branded Product, up to $30.00 depending on the number of products you purchased. The actual amount you may receive may be higher or lower than the above depending on the number of claimants who select this option.

A listing of all covered products is available by clicking the link below. Please review the products and provide the number of products you purchased below:

Covered Products

Number of Covered Products claimed: *

No proof of purchase is required at this time however, the Settlement Administrator may seek additional documentation to verify your claim during the review process. Failure to provide proof, if requested, will result in a denial of your claim.

CERTIFICATION

By signing this Claim submission, I certify, under penalty of perjury, that the information included with this Claim submission is accurate and complete to the best of my knowledge, information, and belief. I am a member of the Settlement Class, and have not submitted a request to exclude myself, or “opt out of,” the Settlement. I agree and consent to be communicated with electronically via email and/or mobile phone text (message & data rates may apply). I agree to furnish additional information regarding this Claim submission if requested to do so by the Settlement Administrator.

Your Signature: *