Consumer Report Copy Request Form

Consumer Report Copy Request Form


Section A: Details of the company that ordered the report

Company Name*?   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*
Social Security Number: Last 4 digits  
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:*