Request Form

In some jurisdictions, applicable law may entitle you to make certain requests in connection with your personal information. Please complete this form if you would like to make a request about your data.

For more information on how Screenvision Direct, Inc. and Screenvision Exhibition, Inc. (collectively Screenvision Media”) handles personal information and how our verification process works, please review our privacy policy found here.

  • Q1 Are you a Screenvision Media client? *


  • Q2 Below is my relationship with Screenvision Media (please check all that apply):
  • Q3 Please tell us more about yourself so we can properly identify you. *




  • 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)? *
  • Q5 Who is the individual for whom you are making this request? Please provide us with the information below: *




  • Q6 What is your relationship to the individual?

    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) *
  • 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:

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