Communication

Please provide the following information. Note that items identified with an * must be provided to successfully communicate your interest in this class action.

First name: *

Last name: *

Street:

City:

Province/State:

Postal/ZIP Code: *

Phone:

E-mail: *

Type of defibrillator:

Serial number of defibrillator:

Date of surgery to implant defibrillator:

Has the defibrillator been explanted?:

Yes

If you wish to provide documents to us by fax, use our toll free fax line 866.316.5308.

If you wish to provide documents to us and do not have access to a fax machine, deliver or mail your documentation to us at

Sutts, Strosberg LLP
Lawyers
600-251 Goyeau Street
Windsor ON N9A 6V4
Attention: Guidant class action

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Guidant Co. - defibrillators

Communication