We regret learning that your device has been damaged, lost or stolen.

For damaged devices:
Complete the service request form below and press submit.  (You may also print the form and fax it to DeviceGuard Inc. at 1-800-618-2910.)
In order to expedite the service process, please ensure that the form is fully completed. You will be contacted within 24 hours of submitting a complete service request. 

For Lost or Stolen devices:
1) Complete the service request form below and press submit. (You may also print the form and fax it to DeviceGuard Inc. at 1-800-618-2910.)
2) Fax or send
         a) a police report describing the incident. 
         b) a valid state ID.
In order to expedite the service process, please ensure that the service request form is fully completed, and that you have faxed or sent a police report and a copy of a valid state ID.
You will be contacted within 24 business hours of submitting a complete service request. 

Cell Phone Information:
Name of Dealer :	*	Cell Phone #:	*
Wireless Carrier:	Choose One Alltell Amp'd Boost CellOne Cingular Cricket Disney Mobile Helio Nextel Pocket Communications Southerlinc Wireless Sprint T-Mobile Verizon Virgin Mobile *	ESN or IMEI #:
Brand:	Choose One Audiovox Cingular Firefly Kyocera LG Electronics Motorola Nokia Novatel Option Pantech Samsung Sanyo Siemens Sierra Wireless Sony Ericsson T Mobile UT Starcom Virgin Mobile *	Model:	*
Date of Purchase:		Contact Phone #:	*
Date Stolen/ Damaged/Lost:	*	Shipping:	Standard $28.50
Please provide a brief description of the circumstances under which your device was damaged, lost, or stolen.  Please include, date, time and place of incident.
IMPORTANT: Your service request will not be processed until all required documentation is received by DeviceGuard Inc. Please read before signing statement: I understand and agree that if, in making this request, I intentionally conceal or misrepresent any material fact concerning this damage, theft, or loss, the entire request is void. I understand and agree that the furnishing or preparation of this request is not a waiver of any of my rights. I have done nothing to violate the conditions of the membership and, to the best of my knowledge, the damage, theft, or loss did not result from, nor was it caused by, any fraudulent act by me or by any other person or thing under my direction of control. Fraud will be prosecuted to the fullest extent of the law, including possible arrest and recovery. The information contained herein and any other that may be furnished in connection with this request is true and correct. I further affirm that the loss or damage is not being repaired, replaced, or reimbursed by any other source.
I have read and agree to the Terms and Conditions above. *
Customer Information The billing address must be entered exactly as it appears on the credit card statement.		Credit Card Payment Information:
First Name: * Last Name: * Address: * City: * State/Prov: Outside US & Canada Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory * Zip Code: * Country: U.S.A. Home Phone: * Email Address: *		Please Collect Payment from User! Card Type: VISA MASTERCARD AMEX DISCOVER * Card Number: * Expiration Month: January February March April May June July August September October November December * Expiration Year: 2007 2008 2009 2010 2011 * Verification Code: * This is the 3 or 4 digit number printed on the back signature panel. It is on the front of the card for American Express.