Mobile History Submission Form
Please provide your mobile device usage and history details below.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Device Brand
*
Please Select
Apple
Samsung
Google
OnePlus
Huawei
Other
Device Model
*
Operating System
*
Please Select
iOS
Android
Other
Primary Usage Type
*
Personal
Work
Both
Period of Use (Start Date)
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Period of Use (End Date, if applicable)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Brief Description of Usage/History
*
Upload Screenshot or Usage Log (optional)
Upload a File
Drag and drop files here
Choose a file
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of
Submit
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