SurveySailor™ Initial Dispute Notice
First Name:*	________________________________
Last Name:*	________________________________
Street Address:*	________________________________
City:*	________________________________
State:*	________________________________
Zip Code:*	________________________________
Email:*	________________________________
Phone Number:*	________________________________
Description of Dispute:*	________________________________
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Desired Outcome:*	________________________________
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Mail or Email Notice to:	SurveySailor
	12600 Hill Country Blvd Suite r-275
	Austin, TX 78738
	[email protected]
	(*Required fields)