SECURITY FREEZE REQUEST

Submitted pursuant to the Fair Credit Reporting Act, 15 U.S.C. § 1681c-1, and applicable state security freeze statutes.

________
________
Telephone: ________
Email: ________

Date: ________

TO:
Equifax Information Services LLC
Equifax Security Freeze
P.O. Box 105788
Atlanta, GA 30348

Sent via: ________

Re: Request to Place a Security Freeze on Consumer Credit File

Dear Equifax,

§ 1. Request. Pursuant to the Fair Credit Reporting Act, 15 U.S.C. § 1681c-1, and any applicable security freeze provisions of the law of my state of residence, I, the undersigned consumer, hereby request that you place a security freeze on my consumer credit file. I understand that this freeze will prohibit you from releasing my credit report, credit score, or any information contained in my file to any third party without my prior express authorization, except as otherwise permitted by law.

§ 2. Identifying Information. To enable you to identify my file and process this request, I provide the following information:

1. Full legal name: ________
2. Any other names previously used: ________
3. Social Security Number: ________
4. Date of birth: ________

§ 3. Current Address. My current address is:

________

I have resided at this address since ________.

§ 4. Prior Address. If I have resided at my current address for less than two (2) years, my immediately preceding address is:

________

§ 5. Proof of Identity and Residence. As required for verification of identity, I enclose with this request legible copies of the following supporting documents:

1. Proof of identity: a copy of my ________, identification number ________.
2. Proof of current residence: a copy of my ________.

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu fugiat nulla pariatur lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud.

Lorem ipsum dolor sit amet consectetur adipiscing elit sed do eiusmod tempor incididunt ut labore et dolore magna aliqua ut enim ad minim veniam quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat duis aute irure dolor in reprehenderit voluptate velit esse cillum dolore eu.

§ 8. No Charge. I understand that, pursuant to 15 U.S.C. § 1681c-1(i), the placement, temporary lift, and removal of a security freeze must be provided to me free of charge.

§ 9. Contact. Please contact me at the address, telephone number, or email address set forth above if you require any additional information to process this request.

Thank you for your prompt attention to this matter. I look forward to receiving confirmation that a security freeze has been placed on my credit file, along with any personal identification number or password that I may need to lift or remove the freeze in the future.

Respectfully,

_____________________________
________
Signed on: ________

Enclosures: copy of proof of identity; copy of proof of residence.