Requester's Full Legal Name *

First Name

Last Name

Sworn Statment *

Please read the following statement, and check the boxes to confirm that you have read and acknowledge them. Statment: Sanders Repair Services will use the personal information that you supply on this form (including your email address and any ID information) and any personal information you may provide in further correspondence for the purposes of processing you request and meeting our legal obligations. We may share details of your request with data protection authorities, but only when they require these details to investigate or review a decision that we have made.

I represent that the information in this request is accurate and that I am authorized to submit this request.

I represent that the information in this request is accurate and that I am authorized to make this request.

I understand that Sanders Repair Services will not be able to process my request if the form is not properly filled out or if the request is incomplete.

Signature *

By typing your full name below, you are providing us with your digital signature, which is as legally binding as your physical signature. You represent that the information you've submitted is accurate.

Signed on this Date of *

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DD

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