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Date
Date
Name *
Name
Phone *
Phone
Do you have a sales receipt for your product or service?
Is your claim currently covered by a contract, service agreement or warranty?
$
Have you contacted anyone at the company regarding your claim?
If yes, do you have documentation (email or phone log)?
(Please note that we do not currently offer resolutions for utility, phone or cable bills.)

INDIVIDUAL RETAILS CLAIM qUESTIONNAIRE  

Please fill out this form and a representative from mycustomeradvocate will get back to you promptly. 

If you need assistance, please call us toll free at 855-720-2361.