Counterfeit Report

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Product Information

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Personal Information

First name

Last name

Phone Number

Street Address

Street Address Line 2

City

State / Province

ZipCode

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Product Information

Name of Product

Message

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Upload a photo of the front of the product:

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Purchasing Information

Name of Store

Date Purchased

If purchased online, provide a link to the site where you bought it

Store Location

Street Address

City

State / Province

ZipCode

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Review

Please review your information to make sure everything submitted is correct and final!

COUNTERFEIT REPORT

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