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SIIA RESELLER PIRACY REPORTING FORM

This form is to report a case of software piracy by hardware or software resellers. SIIA investigators may need to contact you for additional information and will require contact information about you. The asterisks (*) mark fields that must be completed. This form cannot be submitted without all the required information. If you would prefer to report a case over the phone, please call our Anti-Piracy Hotline at (800) 388-7478 or send an e-mail to piracy@siia.net.

All sources are kept strictly confidential. Your name will not be released.

About the Reseller:
Name of Reseller*:
Name of Sales Representative:
Address of Reseller:
City:
State:
ZIP/Postal Code:
Country:
Telephone:
Email Address:
URL:

Did you purchase:
   Hardware with software pre-loaded
   Software only

If you purchased hardware with software together, did the reseller include the software:
   Without informing you about the pre-loaded software
   With your knowledge

What software products did you (or your company) purchase from the vendor?

Software Product(s) # Copies
Purchased