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Your name
Your Email
Your Cell Phone Number
Store Name
Loss type
Cracked Screen
Cracked Back
Liquid Damage
Other Damage
Malfunction / Part failure
Battery failure
Theft
Lost item
Other
Date of incident
Device serial #
Confirm device serial #
Device Make and Model
Current device status
Still fully functional, just some annoyances
Functional, but intermittent issues
Functional, but less than half the time
Completely unusable
Incident description
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Your name
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Your Cell Phone Number
Store Name
Device IMEI
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