claim form final

Claim Form

Enter your claim details, upload item photos, and describe what you’re claiming so we can process it.
Claim Numbers
Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Item #1
Item Description
Amount Claimed/Paid
Photo or Screenshot

Cancelof
Any Additional Details
Do you have another claimed item?
Item #2
Item Description
Amount Claimed/Paid
Photo or Screenshot

Cancelof
Any Additional Details
Claimed Items
Claim Photo

Upload one picture of the claim.
Cancelof
Date of Claim

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
How They Paid
Shipping Information

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Store Name
Claims will not be processed if form is not filled out complete
NO REFUNDS NO RETURNS. Inovices for shipping will be sent out within 5 to 7 business days. Shipping must be paid within three days of invoice being sent out. Please contact your shipping carrier with any shipping questions.
Should be Empty:

Claim Form