File An Appeal

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*

CustomerCurrent EmployeeFormer EmployeeJob ApplicantContratorFormer ContractorBusiness ContactOther
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?*

PhoneEmail
Date of service/occurence*

MonthDayYear
Date
Do you have any documentation to support the appeal?*

YesNo
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.
Should be Empty: