OFFICIAL DON’T GET MAD, GET EVEN PROGRAM APPLICATION Information About the Auction:*
*To report multiple auctions by the same seller, make copies of this page and provide information about each auction separately. Name of Auction Site (ex. eBay): ____________________________________________________ Name of Auction Seller (i.e., Seller’s ID): ______________________________________________ Auction Number: _______________________________________________________________ Date the Auction Closed: _________________________________________________________ Pirated Software Purchased: Software Publisher: _________________________________________________ Software Title: ____________________________________________________ Version: _________________________________________________________ Quantity Purchased: ________________________________________________ How much did you pay for the pirated software? ________________________________________ Have you reported this piracy to anyone else? _______ If so, to whom? ____________________________________________________ What was their response: ____________________________________________ _______________________________________________________________ Did you get your money back? _________________________________________ _______________________________________________________________ Why do you believe the software you received is pirated? _________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Your Contact Information:
First Name: ___________________________________________________________________ Last Name: ___________________________________________________________________ Mailing Address: ________________________________________________________________ Address Cont.: _________________________________________________________________ City: ______________________________ State:_____________________________________ Zip: _______________________________ Country: __________________________________ Telephone: _________________________ E-mail Address: ______________________________ How did you hear about SIIA and the Don’t Get Mad, Get Even Program: ____________________________ ___________________________________________________________________________________ Please provide any additional information about the piracy here: ___________________________________ ___________________________________________________________________________________ By signing this form I understand and agree that: • The information furnished to the SIIA in this application is true based on my personal knowledge. • • • • Prior to purchasing the software I am reporting on this form, I was unaware that I was purchasing counterfeit or pirated software. I have not sold software or have been affiliated with anyone who has sold software on any auction site or any other online or offline outlet. Neither I nor any family member or relative of mine is the seller I am reporting and I do not have any prior or existing non-business relationship with the seller, or assisted or worked with the seller in any way. I have reviewed and agree to all the terms and conditions for participating in the program as outlined in this document.
Name: ______________________________________________________________________________ Signature:____________________________________________________________________________ Date: ______________________________________________________________________________
PLEASE REMEMBER TO INCLUDE WITH YOUR APPLICATION THE FOLLOWING ITEMS: 1. 2. The copy of the software that you obtained from the auction seller who you are reporting; All packaging, documentation, or other materials that were sent to you by, or you obtained from, the auction seller you are reporting, including, but not limited to, envelopes the software was shipped to you in, CD sleeves containing the software, boxes, any documentation that accompanied the software; Copies of any correspondence between you and the seller you are reporting.
3.
MAIL COMPLETED APPLICATIONS TO: Don’t Get Mad, Get Even Program Software & Information Industry Association 1090 Vermont Ave, NW 6th Floor Washington, DC 20005