Data Disclosure Request Page - Copiers | Printers | Ink | Toner

Data Subject Request Form

Personal Information Disclosure Request: This form is intended for residents of California, Colorado, Connecticut, Montana, Oregon, Texas, Utah and Virginia, in compliance with the respective state privacy laws. After submission of an eligible request, a confirmation will be sent which may describe any next steps that may be needed. If you are not a resident of one of the above noted states, we may process your request as a courtesy, but nothing in this form shall constitute or be construed as a legal obligation to do so.

Requestor Relationship to DEX Imaging:(Required)

Resident of:(Required)

State of Residence:(Required)

Type of Request:(Required)

First and Last Name of Requestor(Required)

Email Address of Requestor

Requestor Phone Number(Required)

Requestor Address(Required)

Street Address Address Line 2 City State ZIP Code

Account Number (If Applicable)

Equipment ID(s) If Applicable

Are you requesting on your own behalf?(Required)

Signed(Required)

First Last

Date Signed(Required)

Data Subject Request Form

Site Navigation

Follow Us

Contact Us