Participant Information

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

All users must have a supported (http://www.safercellservice.com/devicelist) Samsung device before proceeding.

Do you currently own a Samsung device? *

Yes

No

Is device supported on platform? *

Yes

No

Samsung Device Model Number:

Samsung Device Serial Number:

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