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Missing Kickstarter Reward Claim Form and Legal Attestation

Name

First Name

Last Name

Required Kickstarter campaign Email

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Note to Shipper

Phone

(Required for Shipping)

Country

(###)

###

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LEVITATING DICE SETS ↓

(Please Select the DICE COLOR)

(Please Select the BASE MATERIAL)

Quantity

(List Only What's missing)

FULL DICE SET (no base, just dice) ↓

(Please Select the DICE COLOR)

Quantity

(List Only What's missing)

LEVITATING DICE With Single D20 ↓

(Please Select the DICE COLOR)

(Please Select the BASE MATERIAL)

Quantity

(List Only What's missing)

Single LEVITATING Dice (a d4,d6,d8,d10,d%,d12 or d20) ↓

(Please Select the DICE COLOR)

Size

Which dice is missing?

Quantity

(List Only What's missing)

Nameplates 01 (Add Customizable for the Levitating Dice Set) ↓

What text would you like on your nameplate? Limit of 25 characters.

Nameplates 02 (Add Customizable for the Levitating Dice Set) ↓

What text would you like on your nameplate? Limit of 25 characters.

Nameplates 03 (Add Customizable for the Levitating Dice Set) ↓

What text would you like on your nameplate? Limit of 25 characters.

By Completing this form, I hereby attest and affirm the following:

○ Truthfulness: All information and statements provided by me, whether written or verbal, are true, accurate, and complete to the best of my knowledge and belief. I have not knowingly made any false, misleading, or fraudulent representations. ○ Disclosure: I have disclosed all relevant facts, data, and information that are material to the matter at hand. I have not intentionally withheld or concealed any information that could be relevant or important. ○ Compliance: I have acted in full compliance with all applicable laws, regulations, and ethical standards. My conduct has been professional, responsible, and in the best interests of all parties involved. ○ Integrity: I have maintained the highest standards of integrity throughout my interactions and dealings. I have not engaged in any unlawful, unethical, or improper activities. ○ Cooperation: I have cooperated fully and in good faith with all relevant authorities, parties, and stakeholders. I have provided timely, responsive, and transparent information as requested. ○ Commitment: I am committed to continuing to act with honesty, transparency, and integrity in all future dealings and proceedings. I understand the importance of maintaining trust and credibility. I understand that this attestation is made under penalty of perjury and that any false, misleading, or fraudulent statements may have serious legal consequences. I hereby affirm that the contents of this attestation are true and correct to the best of my knowledge and belief.

Signature

I understand that this attestation is made under penalty of perjury, and that any false, misleading, or fraudulent statements may have serious legal consequences. I hereby affirm that the contents of this attestation are true and correct to the best of my knowledge and belief.

First Name

Last Name

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LEVITATING DICE SETS
(Please Select the DICE COLOR and BASE COLOR)
Quantity:

Missing Kickstarter Reward Claim Form and Legal Attestation

Coupon Code: “ADDTHIS”