CLAIM FORM MERZON CLASS ACTION

							         Merzon Class Action
         P.O. Box 2876
         Portland, OR 97208-2876




                                                  CLAIM FORM
                                              MERZON CLASS ACTION
                               Please Type or Print in the Boxes Below; Do NOT use Red Ink, Pencil, or Staples

 ELECTION OF PAYMENT
 To make a claim under Option 1 Liquidated Payment in the sum of $100.00, please complete Section A of this packet. To make a claim under
 Option 2 Resultant Damage Payment of up to $250.00 per qualifying window (maximum of $500.00 per building or home), please complete
 Section A and B of this packet.

 PLEASE SELECT PAYMENT OPTION 1 or 2 BELOW
 I/we, the undersigned Homeowner(s), hereby request the following payment option [Please check the box in front of Option 1 or 2]:

   1)               One-time Liquidated Payment of $100 [If you have selected this option, please complete Section A of this packet] OR
   2)               Resultant Damage Payment option of up to $250.00 per qualifying window (maximum of $500.00 per building or home).

               I/we understand that receipt of this payment will be the sole consideration from Atmos Corporation, doing business as Merzon
Industries (hereinafter “Merzon”) and other Released Parties for any damages I/we may have suffered, or may suffer in the future, relating in
any way to the Window Products in the home referenced above, including any claims which were or could have been asserted in Oliver, et al. v.
Atmos Corporation, et al., Superior Court of The State of California For The County of San Joaquin Case No.: CV019362. We hereby release
and forever discharge hereinafter “Merzon” and other Released Parties from any and all claims which were or could have been asserted in the
referenced litigation on behalf ourselves and all family members residing in our home.
               Pursuant to Court directive, I/we declare under penalty of perjury under the laws of the state of California that the foregoing is
true and correct.

               Date:
   Executed             -         - 2 0 0 9 , at _____________________________________________, _______________
                                                                             City                                     State



   Homeowner signature



   Homeowner signature



              v.2                                                                                           03-CA3677
                                                                Section A
PART I: CLAIMANT INFORMATION
 1. Name(s) and telephone number(s) of Persons making this claim:
 Last Name                                                         First Name                                                               MI


 Last Name                                                         First Name                                                               MI


 Day Phone                                                         Evening Phone
             -            -                                                    -            -

PART II: PROPERTY IDENTIFICATION
 2. Street address of the Subject Property for which you are making this Claim: (Do not provide a post office box)
 Address


 City                                                                                               State        Zip Code


 County




PART III: VERIFICATION OF OWNERSHIP OF PROPERTY
 3. Please indicate which of the following you have attached as evidence of property ownership. The document must name all owners and
 provide the address of the property. You must provide at least one of the following:

        a. Copy of the Property tax bill for the current year              c. Copy of current mortgage or loan statement
        b. Copy of the deed showing current ownership                      d. Declaration page from a current property or homeowners
                                                                              insurance policy

PART IV: VERIFICATION OF OWNERSHIP OF ATMOS 480, 580, 920 WINDOWS or 820 DOORS
 4. Please indicate which of the following you have included as proof that the claimed window is a Merzon series 480, 580or 920 window or a
 Merzon series 820 sliding glass door. You must provide at least one of the following:
        a. Photos of the window or parts of window (e.g., latch, weep holes, mullion, night lock, roller attachment)

        b. AAMA label or photos of AAMA label

        c. Copy of contract or invoice for purchase of your home

PART V: ANY PRIOR CLAIMS INVOLVING ATMOS WINDOWS
5. Have you ever been involved in any litigation or claim involving the Subject Property’s construction or design?          YES          NO


6. If yes, did the prior litigation or claim(s) involve any of the windows for which this claim is being made?              YES          NO


If yes, please provide the name of the case, the Court the case is/was being litigated, the case number, the approximate date and the status of
the litigation.




                                                                                                             04-CA3677
                                                               Section B
                     FOR WINDOW RESULTANT DAMAGE REPAIR PAYMENT OPTION ONLY

PART VI: TOTAL NUMBER OF WINDOWS MAKING A CLAIM

 7. Please provide the total number of Merzon windows for which you are making a claim.

PART VII: IDENTIFICATION OF WINDOWS YOU ARE MAKING A CLAIM
 For each window you are making a claim, separately describe the condition of the window at or around each window on which you base your
 claim
  WINDOW LOCATION (e.g., master
  bedroom, second-floor bathroom, etc.)                                   CLAIMED CONDITION (brief description)




** If additional space is needed, please attach a separate sheet.
** Merzon reserves the right to inspect, at its cost and expense, promptly after the Claims Administrator receives a claim, the Class Members’
Window Products about which they have submitted a Claim.

PART VIII: PROOF OF DAMAGE
 8. If you have experienced Resultant Damage adjacent to your Merzon windows and have had the damage repaired or replaced, please provide:
          Invoices, bill or contract reflecting repairs to Merzon Windows; OR

 9. If you have experienced Resultant Damage adjacent to your Merzon windows; but have not had the damages repaired, please provide the
 following:
            A written estimate(s) or inspection reports from licensed contractors in the business of repairing windows and/or related damages.

PART IX: OATH AND CERTIFICATION
  I certify under penalty of perjury under the laws of the State of California that to the best of my knowledge, information and belief, the
  information provided on this Claim Form is complete, true and correct.
  The undersigned also agree(s) to cooperate with Atmos and/or the Claims Office administering this class action settlement during the
  processing of this Claim Form, including during any subsequent inspection of the Property.

  _________________________________________________                           _________________________________________________
  Print Name (Primary Owner)                                                  Print Name (Co-owner)




  Signature (Primary Owner)                                                   Signature (Co-owner)


   Date          -          -                                                   Date          -          -
          (MM)       (DD)       (YEAR)                                                 (MM)       (DD)       (YEAR)

                                                                                                             05-CA3677