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*TIP Consider writing your facts down in a word document on your pc then copy and paste in to the form below, this way you can take your time to explain your situation properly.

Your Name (required)

Your Email (required)

Your Address (required)

Name of Goods / Services Purchased

Date of Purchase / Payment

Name of Retailer / Trader

Method of Payment

Summary of Facts (Max 250 words)

Are you Human?

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