Consumer Report Copy Request Form

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:*
    TO PAGETOP