Martin Schneider et al. v. Chipotle Mexican Grill, Inc.

Case No. 4:16-cv-02200

United States District Court for the Northern District of California

If you received a personalized Claim Deficiency Notice via email with a Claim ID Number and Confirmation Code, please enter the codes you were provided below.

Martin Schneider, et al. v. Chipotle Mexican Grill, Inc.
Case No. 4:16-cv-02200, U.S.D.C., N.D. Cal

Settlement Claim Form

If you purchased beverages or food products containing meat and/or dairy ingredients in a Chipotle restaurant from April 27, 2015 through June 30, 2016, you must complete this Claim Form to be eligible for compensation under the Settlement. The deadline to file a claim online is May 30, 2020.


I. YOUR INFORMATION
* Denotes Required Fields
II. State the combined number of purchases of beverages or food products containing meat and/or dairy ingredients that you made in a Chipotle restaurant from April 27, 2015 through June 30, 2016.

Only 5 valid Claims will be honored per Settlement Class Member without proof of purchase, and 10 valid Claims will be honored per Settlement Class Member with proof of purchase. Only 15 valid Claims will be honored per Settlement Class Household.

Valid proof of purchase must be included with this Claim Form to receive compensation for purchases with proof. Valid proof of purchase includes the following:

  • receipt(s).
  • a copy of the purchase on your credit/debit card statement.
  • other document that you believe evidences your purchase.
III.Please select the manner in which payment will be issued for your valid Claims.

*If you select payment via PayPal, the email address entered at the top of this form will be used to process the payment to your PayPal account linked to that email address. If you do not have a PayPal account, you will be prompted to open an account using the email address entered at the top of this form.

IV. Documentation

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.

File List: No Files Selected

    V. Sign and Date the Affirmation Below:

    I hereby affirm, under penalty of perjury under the laws of the United States, each of the following:

    • I personally purchased one or more beverages or food products containing meat and/or dairy ingredients in a Chipotle restaurant from April 27, 2015 through June 30, 2016.
    • I understand that by not opting out of the Settlement, I have given a complete Release of all Released Claims as described in the Settlement Agreement.
    • The information provided in this Claim Form is true and correct to the best of my knowledge.

    Your Claim Form has been submitted successfully.

    HOWEVER, it appears one or more of the documents you uploaded were not successfully received. Please see below for which file(s) had errors and log back in to your existing Claim online to re-upload your document(s). Alternatively, you can send your documents with your Submitted Claim ID to the Settlement Administrator by email to: @.com.

    Thank you for submitting your claim. Please retain this page for your records.

    Your Claim Details

    Submitted Claim ID:
    Confirmation Code:
    You will need the above Submitted Claim ID and Confirmation Code if you would like to edit your Claim at a later time, so please retain this page for your records.
    CLAIM INFORMATION
    First Name:
    Last Name:
    Street Address 1:
    Street Address 2:
    City:
    State:
    Zip Code:
    Contact Telephone Number:
    Email:
    Signature:
    Date:

    If you need to update your address, please contact the Class Action Settlement by email at info@ChipotleNonGMOClassAction.com.