Sample Title

Sample Important Information & Instructions:

In order to protect your personal information we will validate your identity before mailing your credit report to your confirmed home address. You must provide a photocopy of the front and back of:

Two pieces of government-issued identification
If your address is not up-to-date on either identification, you must also provide an additional document showing your current home address (e.g. a utility bill).
If you provide your Social Insurance Number, we will cross-reference it with our records to ensure that we disclose the correct information to you. Knowing it helps us avoid delays and confusion in case another individual's identifying information (such as name and address) is similar to the one you provided.
If you provide a credit card statement or copy of your credit card as proof, please ensure to blackout your private information.

The information you provide on the form will be used to confirm your identity and may also be used to update your credit report. Such updated information will be stored, safeguarded, used and/or disclosed in the normal course as part of your credit file. For more information about SAMPLE COMPANY’s privacy practices, please see our Privacy Policy at https://www.adobe.com/privacy/policy.html. For clarity, in any case, we will keep a copy of the information you provide to demonstrate that we complied with our obligation to obtain reasonable identification from you.

Please send your completed form with proof of identity to: Lorem inseam dolor sit amen, consentteturor by fax to: XXX-XX-XXXX.Kindly allow X-Y days for delivery. If any corrections to your credit report are necessary you must complete the Credit Report Update form enclosed with your package, or visit SampleURL and click on “How to File a Something” under Our Sample Assistance.

LAST NAME

FIRST NAME, INITIAL

SUFFIX (Sr., Jr., etc.)

CURRENT STREET ADDRESS

APT.

CITY

PROVINCE

POSTAL CODE

PREVIOUS ADDRESS(ES) WITHIN LAST 3 YEARS

PREVIOUS STREET ADDRESS

APT.

CITY

PROVINCE

POSTAL CODE

DATE OF BIRTH

S.I.N.:

NAME OF MAJOR CREDIT CARD:

LAST 4 DIGITS OF MAJOR CREDIT CARD:

Signature

Date

{{$PAY}} YES, I WOULD ALSO LIKE TO PURCHASE MY Sample Company SCORE* FOR $X.XX (tax included)

I authorize Sample Company to charge the payment to my credit card:

{{$V}}Visa

{{$M}}MasterCard

{{$A}}AMEX

Cardholder Name:

Card Number:

Expiry Date:

Note: Cheque and cash payments are not accepted. Cardholder’s name must be same as requestor’s name.

*Sample company’s XY is a product some service providers use when assessing applications for credit and services. It is not part of your sample credit report, but is based on the particular information in your credit file at the time it is calculated. Lorem Ipsem is not the same as the Lorem Ipsem, which is also used by some lenders. Sample Company will provide your sample report free of charge, whether or not you purchase your Lorem Ipsem. Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Sample company can provide more sample services: Sample Address Telephone: 1-XXX-XXX-XXXX Telephone in Sample: 1-XXX-XXX-XXXX

{{#CALCULATEDCARDHOLDERNAME=*CardholderName_es_:signer1:calc([FirstName]+" "+[LastName]+" "+[Suffix])}}

SAMPLE COMPANY

SAMPLE REQUEST TO OBTAIN MY FREE CREDIT REPORT

Sample Important Information & Instructions:

PREVIOUS ADDRESS(ES) WITHIN LAST 3 YEARS