Date: Equifax Security Freeze P.O. Box 105788

Date:

Equifax Security Freeze P.O. Box 105788 Atlanta, GA 30348

Dear Equifax:

I would like to place a security freeze on my credit file.

My name is:

My current address is: Street: City, State, ZIP:

My former address was: Street: City, State, ZIP

My Social Security number is:

My date of birth is:

CHECK ONE: I am an identity theft victim and a copy of my police report is enclosed.

OR I will pay the fee of $__ for placing the freeze by: ____ Enclosed check or money order

____ Credit card (Visa, Master Card, Discover or American Express) _______________________________________ number ________________expiration date

Yours truly,

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