Do Not Sell My Info | Screenvision Media

Q1 Are you a Screenvision Media client? *

No - I am not a client.Yes[group group-client clear_on_hide inline]
My sales representative’s name is
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Q2 Below is my relationship with Screenvision Media (please check all that apply):

I am an employee, owner, director, or officer of a company that runs advertisements in the Screenvision Media networkI am an employee, owner, director, or officer of an advertising agencyI am an employee, owner, director, or officer of a company in Screenvision Media’s exhibitor networkI am a sole proprietor of a company that runs advertisements in the Screenvision Media networkI am an employee, contractor or job applicant at or for Screenvision Media (current or former)I participate/have participated in Screenvision Media marketing activities such as surveys, polls, contests, sweepstakes, screenings and promotionsI am a visitor and/or user of Screenvision Media’s Services.No relationshipOther[group group-relationship-other]
Please specify
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Q3 Please tell us more about yourself so we can properly identify you. *

First Name *

Last Name *

Telephone No

Email *
Q4 Are you making a request regarding your own personal information or on behalf of someone else for their personal information (for example, an authorized agent or parent/guardian)? *

I am submitting a request regarding my own personal information.I am submitting a request on behalf of someone else.
Q5 Who is the individual for whom you are making this request? Please provide us with the information below: *

First Name *

Last Name *

Telephone No

Email *
Q6 What is your relationship to the individual?

I am the parent/guardian.I am an authorized agent.

Note: To verify that you are a parent/guardian or an authorized agent, we will contact you for additional information.
Q7 What is your request? (check all that apply) *

Opt-out of the “Sale” of my personal information.Delete the personal information Screenvision Media collects about me.Information about how Screenvision Media collects, uses and shares my personal information.Access to the personal information Screenvision Media has about me.Unsubscribe me from commercial email messages from Screenvision.
By submitting this form, I certify under penalty of perjury that I am filing a request in connection with data that relates to me. I understand that falsifying information could lead to an improper release of another individual’s personal information. I authorize Screenvision Media to contact me if additional information is needed to verify my request.

Name:

Date:

Request Form