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Contact Information

First Name*

Last Name*

Email Address*

Phone Number*

Country*

State/Province*

Other State/Province

Street Address*

Apt/Unit Number (if applicable)

City*

ZIP/Postal Code*

Brand*

Nature of Inquiry*

Product Name*

Product Code*

5-6 numbers followed by 3-4 letters, located on the bottom of the item, on the tag, or near the barcode on the box, example: 12345ABC

Please include a photo of the product and/or a copy of the receipt (if available)

Accepted formats: jpg, png, pdf. Max 10MB each, up to 5 files.

Retailer Name

Seller/Merchant Name

Purchase Date

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