The Pi Company Dispute Notification Form - Alacourt printable pdf download

The Pi Company Dispute Notification Form - Alacourt

The PI Company Dispute Notification Form - ALACOURT

If you wish to dispute the accuracy of any information contained within the Consumer Criminal

Report you received from The PI Company completed on you by:

____________________________________________________________________________,

please forward us (1) the denial letter along with the criminal report, (2) copy of your Driver’s

License or State I.D. AND (3) Social Security Card with this completed form.

Check one of the following reasons this report was conducted:

____ Consumer Criminal Report: search conducted on yourself

____ Other: ___________________________________________________________

You may fax to (501) 374-2727 or mail to

The PI Company

1 Riverfront Drive, Suite 700

North Little Rock, AR 72114

You will be contacted by The PI Company following the receipt of your signed form. If you

have any further questions, you may contact The PI Company by calling (800) 260-0079.

The following form must be completed in full for processing:

_______________________________________________________________________

Last Name

First Name

Middle Name

_______________________________________________________________________

Address

City

State

Zip Code

_______________________________________________________________________

Daytime Phone No.

Evening Phone No.

___________________________________________________/_________/__________

Social Security No.

Date of Birth

_______________________________________________________________________

Drivers License Number

State Issued

Request for Alternative Disclosure Method

□ I wish to authorize disclosure of my file in a manner other then mail

□ By Telephone:___________________

By Fax :___________________

□ By other means:__________________

Identify all information that you believe to be incorrect.

______________________________________________________________________________

The Pi Company Dispute Notification Form - Alacourt