Scam Recovery Intake Form
Please complete this form to report a scam or fraudulent incident and request recovery assistance. We do not ask for sensitive personal or financial details.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Scam or Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Scam
*
Please Select
Phishing (Email/Website)
Phone Scam
Text/SMS Scam
Online Marketplace Scam
Investment Scam
Romance Scam
Other
Brief Description of What Happened
*
Approximate Amount Lost (if any)
Method Used by Scammer
*
Phone Call
Email
Text/SMS
Social Media
Website
Other
Last 4 Digits of Account, Card, or Reference Number (if applicable)
Immediate Actions Taken (e.g., reported to bank, changed passwords)
Preferred Method of Follow-up
Email
Phone Call
No follow-up needed
Submit Report
Should be Empty: