Phone Claim Request

1
DateTime* This field is required. Failure to provide complete information will result in a rejected request.
2
Please select your company.* This field is required. Failure to provide complete information will result in a rejected request.Choose NONE if your company is not listed.
Select One
Select One
Advanced Improvements LLC
Andrew Arencibia Notary
Duncklee Inc
Eagle Electrical Services LLC
FIREARMS LLC
Grace Family Logistics LLC
Hampden County HVAC Inc.
Heather Sherman Somers Notary
J&S Energy LLC
Jillian R Perkins
Kodra Family LLC
Longino Properties LLC
Losacanos Marine Services LLC
Ludlow Electric LLC
NEEB INC.
NXYM LLC
San Diego Cool Air Inc
Three Knights LLC
TMG Cleaning Services LLC
Trustwave Electric LLC
Vantage Point, Inc.
Walter Electric LLC
NOT LISTED
3
What is your company name?* This field is required. Failure to provide complete information will result in a rejected request.
4
What is your name?* This field is required. Failure to provide complete information will result in a rejected request.
First Name
Last Name
5
What email should we use for updates?* This field is required. Failure to provide complete information will result in a rejected request.
example@example.com
6
What type of request is this?
Warranty (Not Damaged)
Insurance (Physical/Liquid Damage)
7
Please scan/type the device IMEI.* This field is required. Failure to provide complete information will result in a rejected request.There should be a scannable label on the back of the phone and case.
8
Please scan/type the device phone number.* This field is required. Failure to provide complete information will result in a rejected request.There should be a scannable label on the back of the phone and case.
9
Do you need a shipping label to send to our office?* This field is required. Failure to provide complete information will result in a rejected request.We are located at 17613 Woodland Ct, Babcock Ranch, FL 33982
YESNO
10
Where would you like the replacement device shipped to?* This field is required. Failure to provide complete information will result in a rejected request.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
11
Please share anything else we should be aware of for this device.
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: