Fake Product Questionnaire

Simply fill out the form below and click on the "Send Message" icon below. You must complete this form in order to take advantage of the Fake Product Compensation Program and submit your compensation order.

Complaint Verification In submitting this Questionnaire I am representing that I have purchased one or more products that I believed to: (1) come from Alpha Omega Laboratories, but now understand originated from a different supplier, or (2) were true, accurate, and legal as to the trademark, product name, and/or contents represented, but were not.

---------- >>> True False --- (you must click one)

Section I: Customer Information
     First Name:  
      Last Name:  
 State/Province:       Zip Code:  
  Email Address:  
  Daytime Phone:    Extension: 
Section II: Offending Vendor Information

    Name of Seller:  
Website (if appl.):  
 Address of Vendor:  
  Vendor Phone No.:  
  Date of Purchase:  
Name of Product(s):  
Submit any other information about the vendor you feel is relevant:

Section III: Unmet Expectations

Explain how the counterfeit product(s) failed to live up to your expectations:

If you have addition comments, please send email to support@altcancer.net.

Fake Product Compensation Program Specifics
Place Order: Fake Product Compensation Program Order Form
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