1.
Are you a resident of the United States or its territories who purchased, received as a gift, or acquired as part of the purchase or remodeling of a home, a new Class Dishwasher (i.e., a Whirlpool-manufactured dishwasher with a model and serial number listed as eligible for settlement benefits on www.whirlpooldishwashersettlement.com?
(If you answered “No ” to this question, STOP ; you are not entitled to any compensation or benefit under this Settlement.)
Question 1:
Yes
No
2.
Do you have documentation showing that you purchased a Class Dishwasher new, or acquired a new Class Dishwasher as part of a purchase or remodel of a home, or received a new Class Dishwasher as a gift?
(If you answered “Yes” to this question, gather and prepare to upload or mail your documents, and skip to Question 4. If you answered “No” to this question, proceed to Question 3.)
If you answered “Yes” you MUST gather and upload or mail your documents or you will not be entitled to any compensation or benefit under this Settlement.
Question 2:
Yes
No
3.
DECLARATION: I declare under penalty of perjury of the laws of the United States that I have searched for but am unable to find documentary proof, but that I qualify for membership in the class because I either purchased a Class Dishwasher new, acquired a new Class Dishwasher as part of a purchase or remodel of a home, or received a new Class Dishwasher as a gift.
Signature *
Date *
If you were unable to sign the Declaration above to the left , STOP ; you are not entitled to any benefit. If you signed the Declaration, PROCEED TO QUESTION 4.
4.
Was your Class Dishwasher for personal or household use?
(If you answered No to this question, STOP ; you are not entitled to any compensation or benefit under this Settlement.)
Question 4:
Yes
No
5.
Have you previously received from Whirlpool any form of compensation or customer-satisfaction benefit or other goodwill for problems with your Class Dishwasher (e.g., a free or discounted out-of-warranty repair, a free gift card, a cash payment, a partial refund of the Dishwasher's purchase price, a gift of a new product, a discount off the regular price of a new dishwasher, or any other product that you redeemed)?
Question 5:
Yes
No
If yes, provide the dollar amount of the benefit already received:
6.
Do you have documentation showing that within eight years of the date of manufacture you paid out-of-pocket to repair or replace your Class Dishwasher in response to a Diverter Seal Leak, i.e., a leak through the diverter shaft seal and onto the diverter motor or onto the floor to the rear of the dishwasher?
Examples of sufficient documentation for Question 6 include, but are not limited to, service tickets, service estimates, and service receipts that show you experienced this problem.
(If you answered “Yes ” to this question, gather, and prepare to upload or mail your documents. If you answered “No ” to this question, STOP ; you are not entitled to any compensation or benefit under this Settlement.)
If you answered “Yes” you MUST gather and upload or mail your documents or you will not be entitled to any compensation or benefit under this Settlement.
Question 6:
Yes
No
7.
Of the potential benefits described above, do you wish to request cash reimbursed for eligible amounts you paid out-of-pocket to repair a Diverter Seal Leak, or do you wish to request cash rebated on the purchase of a new dishwasher? Select only one option or the other. If you select to have cash rebated on the purchase of a new dishwasher you will receive a rebate form with further instructions.
Cash Reimbursement
Cash Rebate