case 3:12-cv-00519-gcm document 144 filed 05/08/13 page 1 of...

Case 3:12-cv-00519-GCM Document 144 Filed 05/08/13 of 7

EXHIBIT A

1

Case 3:12-cv-00519-GCM Document 144-1 Filed 05/08/13 Page 1 of 29

Welcome to the ZeekRewards Online Claim Filing Website Any entity or person (including, without limitation, persons, partnerships, corporations, joint ventures, estates, trusts, and governmental units)

that believes that it holds a Claim* (each a "Claimant") against Rex Venture Group, llC d/b/a ZeekRewards.com and Zeekler.com {collectively

"ZeekRewards") should submit a Claim (a "Claim") by completing the series of questions relating to its claim by following the links below {a

"Claim Form") if it would like to receive a distribution on account of its Claim.

All Claimants must submit a Claim Form to Kenneth D. Bell (the "Receiver''] on or before 11:59 p.m. prevalllng Eastern Time on 2013, the

deadline established by the District Court for the Western District of North Carolina (the "Court") for the submission of ail such Claims.

Failure to timely submit a Claim Form, submitting an incomplete Claim Form or submitting a Claim Form without supporting documentation

may result in the complete disallowance of your Claim.

The Claim submitted on the Claim Form remains subject to a determination ofthe allowable amount, if any, ofthe asserted Claim. The requests for

information on this Claim form do not constitute and shall not he considered the basis for the determination of any Claim or distribution.

All affiliate Claimants (an "Affiliate") who participated ln leekRewards should submit a separate Claim for each ZeekRewards UserName that it

registered and/or used in regard to ZeekRewards.com.

Points ae<:umulated, awarded or otherwise held by Affiliates will not be considered in an Affiliata's Claim and should not be provided.

• The term Claim means any (a) right to payment. whether or not such righlis reduced to judgment, liquidated. unliquidated, fixed, contingent, matured, unmatured, disputed. undisputed, legal, equitable, secured, or unsecured; or (t>i right to an equitable remedy for breach of performance ifsuch oreach gives rise to a right to payment, whether or not such right to an equitable remedy is reduced to judgment, fixed, contingent, matured, unmatured, disputed. undisputed, secured, or unsecured.

Click here to Register Click here if vou already have a Registration ID and Password


Cfick here if you have forgotten your Registration ID or Password

This is the login screen for parties that have already registered.


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Retail Auction User D Trade Creditor or Independent 0 Former Employee, Director D Taxing or other Governmental A~thorfty D Subrogation Claim of Finandallns,tit~tiog 0 Other (Please provide detailed informatr/:il'l

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Please confirm tllatft.E\itiJ'~i flir ~~~~'tl~irrl tYP~,i~ cilrr~ct.··

Affili~t~[to~I:C 1 .. ,.· .. · i$5,000 I Retail AuctionO~erTot<ll: .~., ... ·. ·' .· I

Trade Creditor/Independent ContactorTotal: I . . . . I Former Employee, Director or Officer Total: I $1,5ool

TaKing or other Governmental Authority Total:

Subrogation Claim of Financiallnstitutioll Total:

Other: I .. $2,5ool TOTAL Payments made toZeekRewards: I $9,oool

TOTAL Payments received from ZeekRewards: -----

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.• ~~·.· ~a~~yJu~~~r:;6~ellan·employee, member, equityih~l~~r,lott!i~r~~d~f~~~r&f·~~ll~~eWardsor~fe~~gr~l~t~~fn~~y 3 •· • ..... entitY (inclu.lli.ng own er~hip ifthe .·entitY is not a natural pll'rso~)ribiplir:son0no ~s ~n e(itJIIIlya\.i, membeij !!qllitVhold'lrt • · otfit:er ofdireCforofzeekfleW..rds? If yes, please provide date$'f~ 1'/hiti\ yoli '{fflh~ap~Htable entity tJr/(lers!..fl held'l:hisrl.le, yiltJ .or.tlteapplitab!eielltitV pr person'stitle, the scope of yilt! o~th~~~pli~bie' ll1ti~;tlf~E!ri~~·~ r!ile\'lithziJ'l~R~~fff~iith~ l'l!rsli,r••·. i .to whom youortlie applicable entity reported to atZeekR~w'ards (iflmown),imdi:lie·rllmulleration, ifany,yotl.orl:heappli._;;llle . ¢ntit\rreceived fOfacting hi this role.


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case 3:12-cv-00519-gcm document 144 filed 05/08/13 page 1 of...

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