PO Box 509124
San Diego, CA 92150
(877) 309-5226
Fax (800) 237-6526
CLT-CRA-LTR-Consumer Report Request-100314-V1
CONSUMER REPORT REQUEST
In order to process your request for a copy of your CoreLogic Teletrack (“Teletrack”) consumer report, please
complete this form and return it to us at the address or fax number provided above.
Last Name: First Name: MI:
Maiden Name or Other Last Names:
Social Security Number: DOB:
Phone Number: State:
Address:
City: State: Zip:
Please include a legible copy of your government-issued identification card (for example, Driver’s
License) containing your address.
If your current address is different from that stated on your government-issued identification card,
please provide one of the following (please ensure your current address is included in the document(s)
you provide):
Utility Bill
Cell Phone Bill
Cable Bill
Military Orders
Addresses of any other residences you have occupied in the last five years:
Address 1:
Address 2:
Address 3:
BY SUBMITTING THIS FORM, I AGREE THAT I AM THE PERSON NAMED ABOVE AND I
UNDERSTAND THAT IT MAY BE A VIOLATION OF FEDERAL AND/OR STATE LAW TO OBTAIN A
CONSUMER REPORT ON ANY PERSON OTHER THAN MYSELF, AND THAT UNDER THE FAIR CREDIT
REPORTING ACT, ANY PERSON WHO KNOWINGLY AND WILLFULLY OBTAINS INFORMATION ON A
CONSUMER FROM A CONSUMER REPORTING AGENCY UNDER FALSE PRETENSES SHALL BE FINED
UNDER TITLE 18, UNITED STATES CODE, IMPRISONED FOR NOT MORE THAN 2 YEARS, OR BOTH.
Printed Name:
Signature:
Date:
