Security Freeze Request
By submitting this form, you are requesting that we place a Security Freeze on your Innovis Credit Report or that we perform an action to an
existing Security Freeze. We will send you a conrmation letter by mail.
Mail to
Innovis Consumer Assistance
PO Box 26
Pittsburgh, PA 15230-0026
*Denotes a required eld. We require this information to verify and protect your identity.
Request Type *
Request a Security Freeze
Request a new Freeze Conrmation Number for an existing Security Freeze
Specic third party temporary lift
Third party name *
Permanently remove an existing Security Freeze
Temporarily lift a Security Freeze
Freeze Conrmation Number *
This eld is only required when performing an action on an existing Freeze
Date from
mm/dd/yyyy
Date from
mm/dd/yyyy
Date to
mm/dd/yyyy
Date to
mm/dd/yyyy
Are you a vicitm of identity theft? Yes, I am a victim of identity theft No, I am not a victim of identity theft
mm/dd/yyyy
xxx-xx-xxxxxxx-xxx-xxxx
Your Information
First Name *
Phone Number *
Last Name *
Middle Name
Sux
Social Security Number *
Date of Birth *
State * ZIP *
Current Address
Address *
City *
Please provide any documentation in support of your Freeze request
Required Documentation
Please include the following when making your request.
1. Proof of Current Address - Please include one of the following: copy of government-issued ID, signed lease, recent utility bill, recent bank
or credit union statement.
2. Proof of Name - Please include one of the following: copy of government-issued ID, Social Security card, birth certicate, marriage license,
Medicaid or Medicare card.
