Claim Form

Deaton v Hotwire Inc. Settlement Website

To make a claim under the Settlement, please provide the following information. All fields are required. All information will be kept private to the Court, the Claims Administrator and the Parties in this case. It will be used only for this Settlement.

*First Name:
*Last Name:
Company Name: (Complete this field only if you are filing a claim on                                                                        behalf of the company.)
*Current Email Address:
*Re-enter Current Email Address:  
*Mailing Address:
Mailing Address Line 2:
*City *State *Zip Code

I want my claim paid in:

Cash refund of 25% of the customer fees I was charged for hotel reservations.
HotDollar credit equal to 65% of the customer fees I was charged for hotel reservations. I understand that HotDollars can be used only towards future purchases on www.hotwire.com. I understand that HotDollars are freely transferrable and can be used for two years from date of issuance.
 

Please read and certify the following:

I certify under penalty of perjury that I (a) was a resident of the United States, and (b) contacted Hotwire through its website (www.hotwire.com) in order to reserve hotel accommodations, and (c) received a price quote for such accommodations from Hotwire that specified a price for the accommodations plus an additional charge for "taxes and fees" or "taxes/fees," and (d) paid Hotwire for the accommodations plus the "taxes and fees" or "taxes/fees."