Consumer Report Copy Request Form

Candidate Resources

Consumer Report Copy Request Form

 

Section A: Details of the company that ordered the report





Company Name*?   I don't know Approximate time the report was issued*   

?  Info Cubic can provide a copy of your background report if our client conducted a background check on you in the past. Because Info Cubic does not maintain a universal database of consumer credit reports, we will not have your individual consumer report on file if you have not previously submitted an application to our clients and authorized a background report.

Section B: Consumer Information

First Name*   Middle Name*
Last Name*   Date Of Birth*
Do you have a Social Security Number? Last 4 digits*YesNo
Address*   City*
State*   Zip Code*
Home Phone*   Mobile
Report Delivery Preference*   Email*

If the identifiers provided do not match what is in our system, we will contact you for additional identification before processing your request.

Section C: Authorization Release

Please complete the following release to authorize the copy request.

Pursuant to the Fair Credit Reporting Act, I authorize Info Cubic to provide me with a copy of my consumer report. I certify that I am the consumer requesting the report as identified in Section B of this form and that all information provided on this form is complete and accurate.

Signature:* Date:*
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