Consumer Rights Request Form
In accordance with applicable U.S. privacy law, and depending on the jurisdiction in which you reside, you may be able to exercise certain data rights regarding your personal information. Please complete this form to submit your request by emailing us at firstname.lastname@example.org.
You may also submit your request by contacting us over the phone at 1 (800) 868-2185.
In some cases, we may require additional information if we are unable to verify your request based on the information you have provided. The personal information submitted in connection with this request will be used to process your request.
By submitting this request via email to email@example.com, I am confirming the following:
1. Accuracy: The information I have provided is true and accurate;
3. Contact: I authorize Dompé U.S. Inc. and or its affiliates and or agent(s) to contact me (and or the Authorized Agent identified in these documents) to verify my identity and to process this request.
Authorized Agents only:
If you’re an Authorized Agent submitting a request on behalf of a consumer, you must submit an email to firstname.lastname@example.org and attach written authorization from the consumer indicating you’ve been authorized to submit a request on the consumer’s behalf. The form must be signed by both you and the consumer. All forms not signed will be rejected.
Note that you also have the right to appeal in the event that we decline to take action on a request exercising one of your rights set forth above, you have the right to appeal our decision.