case 3:12-cv-00519-gcm document 138-3 filed 03/29/13 page 1 of 29zeekrewardsreceivership.com/pdf/ex....
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![Page 1: Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 1 of 29zeekrewardsreceivership.com/pdf/Ex. C - Claim Submission... · 2013-04-10 · Claim Portal ID Login Registration ID](https://reader035.vdocuments.net/reader035/viewer/2022070800/5f0212bb7e708231d402706a/html5/thumbnails/1.jpg)
EXHIBIT C
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 1 of 29
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Clickhe
reifyoualread
yha
veaRe
gistratio
nID
andPassword
Welcometo
theZeekRe
wards
OnlineClaim
Filin
gWeb
site
Clickhe
reto
Register
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 2 of 29
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Claim
PortalID
Login
Registratio
nID
:
Password:
jTest2
OK
Cancel
********
Thisistheloginscreen
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sthath
avealreadyregistered
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Clickhe
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Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 3 of 29
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Claiman
tSum
maryPage
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 4 of 29
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Claiman
tInformation
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 5 of 29
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Registratio
nVe
rification
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 6 of 29
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Create
Claim
PortalRe
gistratio
nID
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 7 of 29
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Clickhe
reto
fileaclaim
Registratio
nCo
mplete
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 8 of 29
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ZeekRe
wards
UserNam
ean
dPassword
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 9 of 29
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Claim
Type
s(Please
checkan
y/alltha
tapp
ly)
Affiliate
RetailAu
ctionUser
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Affiliate
Thisscreen
willbe
displayedon
lyifthisClaim
was
selected
.
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 11 of 29
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Affiliate
(con
tinue
d)
Thisscreen
willbe
displayedon
lyifthisClaim
was
selected
.
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 12 of 29
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RetailAu
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selected
.
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 13 of 29
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Trad
eCred
itoro
rInd
epen
dent
Contractor
AddAn
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rLine
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displayedon
lyifthisClaim
was
selected
.
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 14 of 29
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Form
erEm
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orOfficer
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selected
.
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Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 15 of 29
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Taxing
orothe
rGovernm
entalA
utho
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.
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Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 16 of 29
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SubrogationClaim
ofFina
ncialInstitution
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.
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rLine
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 17 of 29
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Other
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.
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Paym
entsMad
eto
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lyifthisClaim
was
selected
.
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rPaymen
t
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 19 of 29
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Paym
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Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 20 of 29
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Claim
Summary
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 21 of 29
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Additio
nalInformation/Que
stions
AddAn
othe
rLine
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 22 of 29
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Additio
nalInformation/Que
stions
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tinue
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AddAn
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AddAn
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Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 23 of 29
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Additio
nalInformation/Que
stions
(con
tinue
d)
AddAn
othe
rLine
AddAn
othe
rLine
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 24 of 29
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Consen
ttoJurisdiction
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 25 of 29
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Uploa
dSupp
ortin
gDo
cumen
tatio
n
AddAn
othe
rFile
Back
Save
forLater
Continue
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 26 of 29
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Claiman
tSigna
ture
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 27 of 29
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Subm
itFina
lized
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Warning:
IfyouSubm
itFinalized
Claim
below,
your
claim
forthisZ
eekRew
ards
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ewillbe
final.You
willno
thavetheop
portun
ityto
change
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ationthat
youhave
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Youwillho
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itadditio
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tofo
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Back
Subm
itFinalized
Claim
Case 3:12-cv-00519-GCM Document 138-3 Filed 03/29/13 Page 28 of 29
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