Short-Form Claim Form - Sprouts Farmers Market Settlement

SHORT-FORM CLAIM FORM
Tran, et al. v. Sprouts Farmers Market, Inc., et al.
Superior Court Of The State Of California, County Of Los Angeles
Case No.: 22STCV26572 [Consolidated with Case No. 23STCV08339]

I. Your Information

ClaimFormNo

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HiddenLastName*

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HiddenClaimantId*

Notice Number*

Name*

First Last

Address*

Street Address Address Line 2 City State Zip Code

Phone Number*

Email*

II. Your Transaction Information

The records show that you used a credit or debit card for the following transaction(s):

No data found.

III. Please Sign This Form

Payment Option

Please select the Payment Option by which you would like to receive your payment and complete the steps as prompted.

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Chosen Payment Method*

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Payment Token*

Unique ID

Signature*

By completing this Short-Form Claim Form, I declare that I used my own personal card for at least one transaction that is referenced in Section II above.

INSTRUCTIONS FOR THE SHORT-FORM CLAIM FORM
Use this form only if you have received written notice
with a Notice Number that begins with the letter P

I. Deadline For Returning Your Completed Short-Form Claim Form

If you have already received written notice by e-mail which contains a Notice Number that begins with the letter P, this means that the records show that you used a credit card or debit card for one or more transactions at a Sprouts grocery store within the United States during the period between August 16, 2020 and April 15, 2023.

Therefore, if you received written notice by email which contains a Notice Number that begins with the letter P, in order to obtain a payment, you must submit a Short-Form Claim Form attesting that at least one transaction shown in the records was made with your personal credit card or debit card. ^[1] Once you timely submit your Short-Form Claim Form and it is approved you will become an Eligible Settlement Class Member.

You may submit the Short-Form Claim Form by U.S. mail, fax, or on-line submission.

If you are mailing the Short-Form Claim Form, your completed form must be mailed to the following address postmarked no later than August 5, 2026:

Atticus Administration LLC

PO Box 64053

St. Paul, MN 55164

You may also send your completed Short-Form Claim Form by facsimile to the following facsimile number 1-888-326-6411, by no later than 11:59 p.m. Eastern Time on August 5, 2026.

You may also submit your Short-Form Claim Form by completing and submitting an electronic version of the Short-Form Claim Form on the internet at www.SettleInfo.com, by no later than 11:59 p.m. Eastern Time on August 5, 2026.

II. You Must Complete Section I Of The Claim Form

You must complete Section I entitled “Your Information” by clearly printing or typing your information in the appropriate spaces. You must complete all of the spaces, except for your E-mail address which is pre-printed. If your email address has changed, please cross out the pre-printed email address and print or type your new email address.

III. You Must Sign In The Space Provided In Section III Of The Claim Form

You must also sign the Short-Form Claim Form in the space provided in Section III of the Short-Form Claim Form.

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¹ For the purposes of settlement, the terms “credit card(s)” or “debit card(s)” include EBT cards.

Sprouts Farmers Market Settlement

INSTRUCTIONS FOR THE SHORT-FORM CLAIM FORM Use this form only if you have received written notice with a Notice Number that begins with the letter P

Security Verification

INSTRUCTIONS FOR THE SHORT-FORM CLAIM FORM
Use this form only if you have received written notice
with a Notice Number that begins with the letter P