Account Recovery Request Form

Social Media Platform Name *

FacebookInstagramTwitter (X)LinkedInTikTokYouTubeOther

Username *

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Name on Platform *

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Email Address Linked to Account *

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Phone Number Linked to Account *

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Date of Account Creation (if known)

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Last Login Date *

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Location of Last Login *

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Previous Passwords (if remembered)

Security Question (if any)

Additional Notes