Privacy Submission Form

This form is used to submit a privacy issue to our company's Privacy Response Center. Please fill in as much information about the issue as possible. Feel free to leave some fields with their default value if you are not sure what to enter in the field. The completed form will be placed into our PRC database. If you provided your contact information you should receive a response from us within 24 hours of your submission.

If you have an issue other than a privacy issue with which you need assistance please visit our support site at http://support.psample.com.

Issue title:

Your name:

Email address:

Product or web site:

Issue type: Other

Description of issue:

Severity:

    1 - Issue causes loss or exposure of personal data
    2 - Issue infringes on my privacy
    3 - Issue makes me feel uncomfortable

Priority:

    1 - Must fix as soon as possible
    2 - Must fix in next service release
    3 - Should fix in next product release

Steps required to reproduce the problem: