Join the Class Action

In order to participate in this putative class action, please (a) fill out all information requested below, (b) read all statements herein pertaining the lawsuit, specifically the statements contained in the ‘Hydroxycut Retention Agreement’, (c) click both checkboxes at the bottom of the form after reading, understanding and agreeing to the statements beside such checkboxes and (d) press the ‘submit’ button.

All bold fields are required!

Contact Information

First Name:
Last Name:
Email:
Address:
City:
Province:
Postal Code:
Phone (Day):
Phone (Evening):
Fax:

For Purchasers of Hydroxycut Products

Which Hydroxycut Products did you purchase?

What quantity did you purchase (number of pills, size and number of packages etc.)?

When did you make the purchase(s)?

What side effects are you experiencing (if any)?


Retention Agreement


I [the Plaintiff] declare under penalty of perjury that the information entered is accurate, and I further declare that I have read and understand the terms and conditions of this Agreement and agree to be bound by them.

By placing a check mark in the box to the left and clicking the "SUBMIT" button below, I agree to sign and execute this Retention Agreement with Juroviesky LLP (understanding fully that my actions hereunder represent a replacement for my handwritten signature). I further acknowledge that by clicking the button below, I agree to accept an electronic version/record of the above Retention Agreement (which I am able to print) in place of a written/hardcopy record of same.

 


Telephone: (416) 481-0718
Toll Free: (877) 578-7529 (JRUSLAW)
Fax: (416) 481-1792
Email: info@juroviesky.com
Juroviesky LLP
Toronto (Head Office)
4950 Yonge Street, Suite 904
Toronto, Ontario
Canada
M2N 6K1