ABTM Fraudulent Activity Report
Please provide thorough and accurate responses to all questions.  
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CUSTOMER DETAILS
Customer Full Name *
Customer Phone Number *
Customer Email Address *
Customer Date of Birth *
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Customer Address *
Government Issued ID (Issuing State, ID/DL #) *
INCIDENT DETAILS
Date of Incident *
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Time of Incident *
Time
:
Location of Incident *
Fraudulent Transaction Amount(s) (Total in USD) *
Do you, in fact, own and control the Bitcoin wallet where funds were transmitted? *
NATURE OF INCIDENT
Detailed description of what happened, including how the customer was approached, details of communications with suspected fraudsters, or why fraudulent activity is suspected.   Please provide as much information as possible.
Detailed Description of the Incident *
Do you have any supporting documents (screenshots, emails, transaction IDs)? *
SUSPECT DETAILS
If applicable.
Suspect Name / Alias *
Suspect Contact Info (If Known) - Phone Number, Email Address, Etc.,  *
Description of Suspect (Physical Description, Online Profile Details, Accent, etc.,) *
LAW ENFORCEMENT REPORTING
If applicable.
Police / agency report filed? *
If yes, agency where report was filed: 
If yes, case or reference number: 
CONCLUSION
Thank you for completing and submitting this form.  Our team will review and follow up to request additional information, if necessary, and to provide next steps. 

Additionally, we recommend reporting incidences of fraudulent activity to the FBI's Internet Crimes Complaint Center at www.ic3.gov.  
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