Consumer Disclosure

Electronic Request Form

You may order information on yourself or someone whom you have legal authority over, such as a minor. If you are ordering information for someone other than yourself, you will need to submit paperwork to prove you have authorization. Please call to speak to a live LexisNexis Risk Solutions Consumer Center representative at 1-888-217-1591 or contact us by email at consumer.documents@LexisNexis.com.

To submit a request using the Consumer Request Form, you are required to provide your First Name, Last Name, Street Address, City, Zip, and Date of Birth. You are also required to provide one of the two following optional fields: Social Security Number or Your Driver’s License and State.

For more information on submitting a request using this secure form view the Electronic Request Form Instructions .

Please complete all of the sections on the form so that we may properly process your request.

First Name

Middle Name

Last Name

Suffix

Resident Address

Street Address

City

State

Zip

My Delivery Address is Not the Same as My Resident Address

SSN

Phone

Date of Birth*

Driver's License Number

Driver's License State

Mask My Personal Information

Select Mask My Personal Information to request that the Personally Identifiable Information (PII) contained in your LexisNexis^® Consumer Disclosure Report or FACT Act Report be masked. These reports are unmasked by default.

Consumer Portal

Electronic Request Form

Resident Address

Delivery Address (Mailing Address)

Acknowledgment Message