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Case Code: WCH

Date: January 27, 2016

Contact phone number: (215) 588-5290

Email Address: tsmith@horizonenineers!"om

1. Bought an eligible

machine?

 #es

2. Selected Benefit(s: Cash re$ate %or the &ur"hase o% a ne' it"heni*,

enmore, or Whir+&oo+-$ran* *ish'asher!

Certification a%%irm that a++ in%ormation &roi*e* in .arts an* o% this

C+aim /orm is true an* a""urate that my ish'asher

e&erien"e* an 3erheatin 4ent 'ithin 12 years a%ter

&ur"hase an* that in"urre* unreim$urse* e&enses

$e"ause o% that 3erheatin 4ent in my ish'asher!

C+aim /orm e"ei&t

!han" #ou. #our claim form has been submitted. $lease print this page as %ourreceipt.

#our Claim &umber is 1')*+',+-1. $lease retain this number for %our records.

C /33

4:3 ;H

101< 4=4; :4W

4; =44:4, . 180>1-2262

C /33

$lease print this page and retain it for %our records.

or more information about the settlement and the claims filing process/ please re0ie the

Class &otice.

Chambers v. Whirlpool Settlement

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