File An Appeal

You can use this form to submit an appeal regarding your rights or services rendered. You are encouraged to provide a detailed account of your experience. Your feedback is important to us and we appreciate the time you have taken to share this information. For more information regarding how we use your personal data, and your rights, please see our privacy notice.

Appeal: File an Appeal to formally express your dissatisfaction with the resolution of a rights request or services received.

* Denotes required fields.

I am a

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

Email

example@example.com

Fujifilm product or service related to your inquiry

Other

Please Note: Please tell us how to contact you in case we have questions about your appeal. Best way to contact you?

Date of service/occurence

Date

Do you have any documentation to support the appeal?

Description of the concern or issue?

Please include to the best of your ability all relevant dates, names of individuals directly involved, any phone numbers where you made contact, any specifics on the type of service/rights you are attempting to access or refused and any other details that you believe will assist in the investigation or resolution of this matter.