Customer Account Block Form
Please complete all fields below to request a block on a customer account. Ensure all details are accurate to help us process your request efficiently.
Customer Full Name
*
First Name
Last Name
Customer Account ID or Username
*
Customer Email Address
*
example@example.com
Customer Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Account Block
*
Please Select
Fraudulent Activity
Terms of Service Violation
Customer Request
Non-payment
Other
Block Type
*
Temporary
Permanent
Effective Date of Block
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested By (Your Name)
*
First Name
Last Name
Your Department
*
Please Select
Customer Support
Fraud Prevention
Billing
Technical Support
Other
Internal Notes (visible to staff only)
Attach Supporting Documentation (if applicable)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Block Request
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