Brand Impersonation Incident Report Form
Use this form to report suspected impersonation of a brand so the incident can be reviewed and investigated.
Reporter Information
Full Name
*
First Name
Middle Name
Last Name
Organization / Company Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Incident Details
Report Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Brand Being Impersonated
*
Impersonation Type / Channel
*
Please Select
Website
Social Media Profile
Email
Advertisement
Message
Product Listing
Phone Call
Other
Where Was the Incident Encountered?
*
Detailed Incident Description
*
Is the Issue Ongoing?
*
Yes
No
Impact / Severity
*
Please Select
Low
Medium
High
Urgent
Evidence and Follow-up
Impersonation URL or Handle
Evidence Upload
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Response or Action Already Taken
Additional Notes
Preferred Follow-up Contact Method
Please Select
Email
Phone
Messaging App
No Preference
Submit Report
Should be Empty: