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First Name

Last Name

Phone Number

Address

Street Address (PO Box not accepted)

Address Line 2

City

State / Province

Zip / Postal Code

Country

Product Brand

Product Name

If you purchased live creatures (ants or caterpillars) at unclemiltonstore.com, please provide your order number below

Product UPC

What retailer was this product purchased from?

Date of Purchase (mm/dd/yy)

Did you attempt to return product at store/retailer?

Reason For Inquiry

Please include photo of product highlighting area of issue.

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