Online Claim Form

If you'd prefer to print and mail or email your submission, please click here to download a printable version of the Claim Form. Otherwise, please proceed with the Online Claim Form below.

If you paid or incurred an Industrial Waste Charge (“IWC Charges”) imposed by the City of Detroit (the “City”) and/or a “Member Community” of the Great Lakes Water Authority (“GLWA”) at any time between July 18, 2013 and June 30, 2023, you are a member of the Class in this Action. If the Court approves the Proposed Settlement described in the Notice, you will be entitled to a refund.

You must submit a Claim Form to receive a cash refund as part of this Class Action Settlement.

NOTE: If you received multiple Notices, each Notice is associated with a separate service address. The “Service Address” is the address that incurs the IWC Charges. Please submit a separate Claim Form identifying:

(1) Each service address for which you paid or incurred IWC Charges imposed by the City and/or GLWA, and

(2) The mailing address where you would like us to send your refund check.

If you paid or incurred IWC Charges for more than one property during the class period, you can submit multiple claims requesting that refunds be sent to the same mailing address. Do not submit more than one claim for the same service address.

IF YOU WISH TO SUBMIT A CLAIM FOR SETTLEMENT BENEFITS, YOU MUST COMPLETE THIS ONLINE FORM OR COMPLETE THE PAPER CLAIM FORM AND MAIL IT TO THE CLAIMS ADMINISTRATOR. ALL CLAIMS MUST BE RECEIVED ON OR BEFORE JANUARY 24, 2024.

Claim ID

Claim ID is optional but can be found at the top right of the pages on the Claim Form attached to the mailed Notice.

Filing claim as ...

Note: Refunds checks will be made out to the business or the individual, based on the selection above.

First Name

Last Name

Business Name

Mailing Address:

Address 1

Address 2

City

State

ZIP Code

Contact Phone

Email Address

This is Page 1 of 3. You must complete all 3 pages to submit a claim.