Early Warning
Consumer Identification and Certification Form
Early Warning takes the privacy and security of consumer personal information very seriously. A copy of your consumer report
will be provided upon proper identification, as required by the Fair Credit Reporting Act (FCRA). Please complete all applicable
information, print, sign and submit this form with a copy of identification. See page 2 for return instructions and ID
requirements. Consumer reports are sent within 15 days, as required by the FCRA, unless otherwise required by the
consumer’s state of residence*.
Consumer Information
Last Name First Name Middle Initial Suffix
Name(s) Previously Used
Current Street Address (include Apt #) City State ZIP Code
City State ZIP Code
Mailing Address (if different)
Daytime Phone # Alternate Phone #
Social Security #
-
-
Date of Birth
ID Type:
Driver’s License
ID Card
Passport
Other (explain)
DL #
ID #
Passport #
Issuing State
Issuing State
Issuing Country
Issuing Country
Issuing Country
Copy of
one type
required
Account Information
(Complete if applicable)
Financial Institution Name Routing # Account #
To list additional accounts, please include on a separate page.
Business Entity/Principal Information
(For business accounts - also complete Consumer Information section)
Business Name Tax ID #
Business Address City State ZIP Code
Position (President, Owner, etc.):
Pursuant to the Fair Credit Reporting Act and other applicable laws, I request that Early Warning provide to me a copy of the information in its files
pertaining to me as specified in this Form. By submitting this Form, I certify to Early Warning that: (i) I am the consumer identified in this Form; (ii) all
information provided herein is complete and accurate; (iii) I understand that Early Warning may verify that the information I have presented on this form
is accurate and valid with third party sources.
The personal information you provide to Early Warning will only be used to respond to your request for a consumer file disclosure. Early Warning does
not share or sell this information to any unauthorized parties.
Signature:
Printed Name:
Date:
*RI – 4 business days; CA and LA – 5 business days; Maine – promptly.
©2017 Early Warning Services, LLC. All Rights Reserved. All trademarks referenced in this material are the property of their respective owners
https://www.earlywarning.com/consumer
Please send my consumer report by:
U.S. Mail Email
