1. Are you legally blind?
2. Have you visited the Fashion Nova website (https://www.fashionnova.com) with the intention of visiting a Fashion Nova physical store?
3. During your visit to the Fashion Nova website (https://www.fashionnova.com), did you attempt to find a physical store location on Fashion Nova’s website but were unable to do so after reasonable diligence?
4. In what state were you living when you visited the Fashion Nova website?
5. What were the approximate dates of your visit to the Fashion Nova website?
I declare under penalty of perjury that I am legally blind and that the information provided in this Claim Form, to the best of my knowledge, is true and correct.