Claim Form

Claimant Information

Provide your name and contact information below. This information will be used to deliver your Settlement Voucher and communicate with you if any problems arise with your Claim.You must notify the Settlement Administrator if your contact information changes after you submit this claim form.

Certification & Signature

By submitting this Claim Form, I declare that during the Class Period, as defined below, I made one or more purchases at an Ann Taylor Factory Store or LOFT Outlet Store in part because they were advertised as discounted prices. Class Period means:

• For California and Washington Class Members: September 4, 2020, to November 4, 2024;
• For New York and Wisconsin Class Members: September 4, 2021, to November 4, 2024;
• For Oregon Class Members: September 4, 2023, to November 4, 2024;
• For Pennsylvania Class Members: September 4, 2018, to November 4, 2024; and
• For Texas and Ohio Class Members: September 4, 2022, to November 4, 2024.

I attest, under penalty of perjury, that I am a member of one of the Classes of persons described above. I agree to release all the claims, known and unknown, stated in Section III.D of the Settlement Agreement. I submit to the jurisdiction of the Superior Court of California, County of San Diego, with regard to my Claim and for purposes of enforcing the release of claims stated in the Settlement Agreement.

I am aware that I can obtain a copy of the Full Notice and Settlement Agreement on this settlement website or or by writing the Settlement Administrator at the email address: info@PBOCPricingSettlement.com or the postal address: Binder, et al. v. Premium Brands OpCo LLC, c/o Settlement Administrator P.O. Box 25226, Santa Ana, CA 92799.

I agree to furnish additional information to support this Claim if required to do so.

I agree that by submitting this Claim Form I certify under the penalty of perjury that the foregoing is true and correct to the best of my knowledge and that signing below constitutes my electronic signature on the date of its submission.

The Settlement Administrator and/or Ann Taylor may verify your Claim.