In Re Cobra Sexual Energy Sales Practices Ligitation Case No. 2:13-cv-05942-AB-Ex U.S. District Court for the Central District of California Claim Form (With a Proof of Purchase) First Name Last Name Email Mailing Address City State ---AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasU.S. Virgin IslandsUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Phone Are you a California resident who purchased between August 14, 2009 and December 31, 2020, Cobra Sexual Energy for personal or household use and not for resale or distribution? YesNo Please attach your proof of purchase. I hereby certify under penalty of perjury under the laws of the United States that the foregoing is true and correct.