ECOM PARTNERS, INC Report Form
All information obtained here is confidential & will not be publicly shared
Victim Information
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
State that you reside in
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Incident Information
Date of Signed Contract with ECOM PARTNERS, INC
-
Month
-
Day
Year
Date
How did you pay for the Amazon/Wal-Mart Automation Store/FBA?
Wire Transfer
Crypto Currency (BTC/ETH)
Credit Card
Loan
Combination of all of the above
Other
Name of LLC used to open store/stores. If multiple, please list them all.
Narrative / Testimony (please describe what happened in detail.)
Who referred you to ECOM PARTNERS, INC/Affiliate/Salesperson? (List N/A if you do not have the requested info)
*
[ADDITIONAL] Who referred you to ECOM PARTNERS, INC/Affiliate/Salesperson? (List N/A if you do not have the requested info)
Estimated Total Value of Losses $
Please upload your signed contract with ECOM PARTNERS, INC, and/or Affiliates.
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Additional Documents: Conversations, including group conversations with a member of ECOM Partners, Inc. / affiliate (Texts, WhatsApp, Skype, etc.)| [Wire] transfer of funds (ex: initial deposit) | Invoices | Credit Card statements | Company’s article of organization | Store Records, etc
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