Samsung Galaxy Note 7 Registration

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* Required information.
First Name *
Last Name *
Phone Number *
Email Address *
P.O. Box/Street Address *
City/Town *
Province/State *
Country *
Postal/ZIP Code *
Purchase Date *
Purchase Location *
Has your device experienced a failure? *
If yes, were you injured by the failure?
Have you been contacted by Samsung regarding the recall? *
If yes, how were you contacted?
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