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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

(###)

###

####

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

Missing Kickstarter Reward Claim Form and Legal Attestation

Coupon Code: “ADDTHIS”