DATA PRIVACY RIGHTS REQUEST FORM

DATA PRIVACY RIGHTS REQUEST FORM
If you have any questions regarding this form, please contact Victory by emailing compliance@victory-es.com

Note for Authorized Agents/Representatives: If you are an authorized agent/representative completing this form on behalf of another, please complete this form using the information of the individual for whom you have authorization to make this request; however, please also provide your contact information in the Authorized Agent/Representative section at the bottom of this form.
Who is the Request for?
Name

First Name Last Name
Email
example@example.com
State/Province

Street Address

Street Address Line 2

City

Zip CodeCountry
Relationship to Victory (Select all that apply)
Type of request (Select all that apply)
Additional Comments
AUTHORIZED AGENT/REPRESENTATIVE

If you are submitting this form as an authorized agent/representative of the above-referenced individual, please provide your contact information below.
Name

First NameLast Name
Email
example@example.com
By submitting this form, I am confirming that: (1) the information I have provided is true and accurate; (2) I understand that the information will be handled by Victory in accordance with its Privacy Policy (https://www.victory-es.com/PrivacyPolicy); and (3) Victory and/or its authorized representatives may contact me using the information to verify my identity and to process this request, as applicable.
Should be Empty: