If you did not receive a notice packet in the mail, but you believe that you qualify as a direct purchaser Class Member and would like to receive notice directly by mail or email going forward, please complete this form and make sure to include: your name, company name, address, the Defendant from whom you purchased Broiler Chicken Products, and any relevant purchase details during the Class Period.

This is not a Claim Form. No proceeds from the Settlements will be distributed to qualifying Class Members at this time, but Class Counsel intend to combine any distribution of the proceeds from the Settlements with proceeds from future settlements or other recoveries in the litigation. You will be provided further notice of any such future settlements or recoveries, and at the time settlement proceeds are to be distributed to qualifying Class Members, you will be provided a claim form.

Instructions: Fill out each section of this form and sign where indicated. You may be contacted if further information is required.

Claimant Information