Suburban Express Payment Request Form


If you are a current or former customer of Suburban Express, Inc., you may be eligible for a one-time payment of up to $20, pursuant to the consent decree entered April 9, 2019 in State v. Suburban Express Inc. et al., No. 18-cv-2861 (N.D. Ill.) (The "Consent Decree"). The payment process is available to customers of Suburban Express, Inc. who made purchases between April 23, 2014 and April 9, 2019.

If you wish to receive a one-time payment, please complete and submit this form ("Payment Request"). To be eligible for a payment, you must submit the completed form no later than October 6, 2019. If you are an eligible customer and your submission is approved, we will remit payment to you via check at the name and address you list below.

Please note that neither the submission of this form, nor any information provided by you in this form, automatically entitles you to a payment. All payments by the Office of the Attorney General are subject to, and conditioned upon, compliance by the defendants with the terms of the Consent Decree.

Please provide the following information:

By Submitting this form, you acknowledge and understand the following:

The information I submit on this form will be shared with the Office of the Illinois Attorney General, which may contact me. I understand that the Attorney General is not my private attorney, but represents the public to enforce State laws. If I have any questions concerning my legal rights or responsibilities, I should contact a private attorney. Under most circumstances, my payment request, and any documents submitted with my request, may be considered a public record and may be available to a member of the public upon request, subject to the exemptions provided under the Freedom of Information Act, 5 ILCS 140/7 and 5 ILCS 140/7.

In the event of a payment, a check will be made out to the name and address of the person listed above.


I hereby affirm and attest under penalty of perjury that the above information is true and correct.