Fillable Printable Sample Annual Credit Report Request Form
Fillable Printable Sample Annual Credit Report Request Form
Sample Annual Credit Report Request Form
ANNUAL CREDIT REPORT REQUEST FORM Page 26
Equifax: _____ Experian: _____ Trans-Union: _____ Date of Request: __________
I want a credit report from (check each that you would like to receive):
Check here if, for security reasons, you want your credit report to include no more than
the last four digits of your Social Security Number. _____
Client # 1
Social Security Number: _____-____-_______ Date of Birth: ____-____-________
First Name: ________________________________________ M.I. ______________
Last Name: __________________________________ JR, SR, III, etc.: ____________
Current Mailing Address: _________________________________________________
City: __________________________________ State: ______ Zip Code : __________
Previous Mailing Address (complete only if at current mailing address for less than 2
years): Address: _________________________________________________________
City: ___________________________________ State: ______ Zip Code: __________
Drivers License # _________________________ State: _______ Exp Date: _________
Printed Name: __________________________Signed Name: ____________________
Client # 2
Social Security Number: _____-____-_______ Date of Birth: ____-____-________
First Name: ________________________________________ M.I. ______________
Last Name: __________________________________ JR, SR, III, etc.: ____________
Current Mailing Address: _________________________________________________
City: __________________________________ State: ______ Zip Code : __________
Previous Mailing Address (complete only if at current mailing address for less than 2
years): Address: _________________________________________________________
City: ___________________________________ State: ______ Zip Code: __________
Drivers License # _________________________ State: _______ Exp Date: _________
Printed Name: __________________________Signed Name: ____________________
Client # 3
Social Security Number: _____-____-_______ Date of Birth: ____-____-________
First Name: ________________________________________ M.I. ______________
Last Name: __________________________________ JR, SR, III, etc.: ____________
Current Mailing Address: _________________________________________________
City: __________________________________ State: ______ Zip Code : __________
Previous Mailing Address (complete only if at current mailing address for less than 2
years): Address: _________________________________________________________
City: ___________________________________ State: ______ Zip Code: __________
Drivers License # _________________________ State: _______ Exp Date: _________
Printed Name : ________________________ Signed Name: _____________________
Each client requesting copies of their credit reports must send along with this
completed request form, copies of their state drivers license, and social security card
