Submit Claim

I. Provide Your Contact Information:

First Name *

Last Name *

Street Address (Mailing Address) *

City *

State *

Zip Code *

Email Address *

Phone Number *

* Required Fields

II. Check the Appropriate Box(es) and Enclose Your Documents:

I Want to Be Reimbursed for the Money I Spent Buying DeckOver

If you check this box, you must provide both:

Proof that You Bought DeckOver – This can be a receipt, photo of opened DeckOver containers, formula sticker or UPC label, or other competent proof: AND
Proof of Problems with DeckOver – This can be a photo of your deck, invoices or estimates for repairs, or other competent proof.

I Also Want to Be Reimbursed for the Money I Spent Repairing My Surface

If you check this box, in addition to the items above, you must also provide either:

Proof Regarding Cost of Repairs – This could be an estimate or invoice from a contractor to repair the damage, a receipt for supplies or equipment you used to repair your deck, or other competent proof: OR
Attestation – If you cannot provide documents showing how much you spent, you must provide an explanation:
I applied DeckOver to real property owned or leased by me that caused damage in the form of:

and that I repaired by:

III. ADR Option:

If you are dissatisfied with the relief offered, you may participate in alternative dispute resolution ("ADR") by checking this box. The ADR would be conducted before Hon. Wayne Anderson (ret.) at JAMS, at Behr's expense and based on written submissions only (unless you request otherwise).

IV. Provide the Following Information:

Number of Gallons Purchased:		Approximate Date of Purchase:
Price Paid per Gallon (if known):		Approximate Square Footage of Surface:

V. Purchase Receipts

Accepted file types are: PDF, TIF, JPG, GIF, PNG. Other file types will be rejected. Please confirm in the grid below that your file has been successfully uploaded.

Select File for Upload:

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VI. Fill Out and Sign the Following Attestation:

I declare under penalty of perjury under the laws of the United States that I am a Class Member (as defined in the Class Notice), and that the information in this Claim Form and any documentation attached to it are true and correct to the best of my knowledge. If I did not provide required documents, it is because I do not have them.

Signature: Date:

Bishop, et al. v. Behr Process Corporation, et al.

United States District Court for the Northern District of Illinois

Case No.: 1:17-cv-04464 (N.D. Ill.)

Your Deficiency/Denial Response has been submitted successfully.

Your Claim has been submitted successfully.

Submitted Claim ID:
Confirmation Code:
CLAIM INFORMATION
First Name
Last Name
Street Address
City
State
Zip Code
Email Address
Phone Number

Signature
Date