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2. First Name*
3. Last Name*
5. Phone Number*
6. Email*
8. Shopping Cart(s) Location*
10. Retail owner of shopping cart

    Example: Fred Meyer, Target, Costco, Safeway, etc. 

11. Number of shopping carts
    -- Select One --12345+

    Please select the number of carts to recover

Leave This Blank:


13. 1. Receive an email copy of this form.
14. Email address

    This field is not part of the form submission.

15. Submit

* indicates a required field