To submit a verified customer request to know information or for deletion, please complete the form below, or download and email the completed form to

Section 1 - Information about you or the individual whose information is being requested

Electrolux will only release information to the person that the information relates to. If the request is being made by an authorized representative, the authorized representative must also complete Section 2 below.

First Name
Last Name
Any other applicable names
Current Address
Address Line 2
Zip Code
Previous Address
Address Line 2
Zip Code
Telephone Number
Email Address
Alternate Email Address
Preferred final response method
Are you a current or previous Electrolux employee
Type of Request

Section 2 - Authorized Representative (if applicable)

(If completed, Electrolux will only reply to the address/email address in this section)

Are you acting as an Authorized Representative for another person?

Section 3 - Details of information

You have the right to access and receive a copy of the Personal Information we hold about you in manual or electronic form. Information relating to third parties which may be part of a record or other information exempt under applicable law(s) will not be provided or will be redacted (blacked out).

Type of Information - Please describe the type of information you are requesting or would like deleted.

Section 4 - Declaration if Requesting Specific Information or Deletion

Please type your name below to acknowledge under penalty of perjury that the information supplied in this request is correct and you are the individual to whom it relates or the authorized representative of that individual. In accordance with the federal Electronic Signatures in Global and National Commerce Act, 15 U.S.C. Section 7001 et seq. (“ESIGN”), you hereby agree to execute this Declaration using electronic means including the use of an electronic signature, which shall have the full force and legal effect as if the electronic signatures were traditional handwritten signatures. You acknowledge that you have the ability to retain this Declaration either by printing or saving it. Electronic signature means any “electronic sound, symbol, or process attached t o or logically associated with a contract or other record and executed or adopted by a person with the intent to sign the record.” 15 U.S.C. § 7006(5).

Signature/e-Signature of Applicant
Signature Date