Fillable Report Request Form printable pdf download

Report Request Form

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Dear Consumer:

Microbilt and its wholly owned subsidiaries, PRBC and CL Verify, maintain consumer databases and permit

each consumer to obtain one free copy of their own consumer report from our databases per year, a free

copy of their own consumer report upon each adverse action taken, which includes having an application

for credit declined, and subsequent copies upon request.

To obtain a copy of your consumer report from Microbilt, please complete and sign the attached Report

Request Form and return it to us via US Postal Service along with all of the requested information and

documentation. Note that you do not have to use our Form, as long as you provide all the information

that is requested therein. Our Form is being provided as a convenience to you.

To obtain a free copy of your consumer credit report from one or more of the national consumer

credit bureaus (Equifax, Experian and TransUnion), please visit

For your protection, we need to properly identify you prior to sending you your consumer

report. Accordingly, along with the completed and signed Report Request Form, please send

to us a clear copy of both sides of your Driver's License or state identification card.

Alternatively, you may send any 2 of the following types of identification information:

A copy of a recent (no less than 60 days old) cable, utility or phone bill, with a

matching address of request.

A copy of your Social Security card.

A copy of your birth certificate.

A copy of your US passport (picture page only).

A copy of your voided consumer check with matching address of request.

A copy of your Alien Registration Card.

Once we have received your completed and signed Report Request Form and requested documentation

and verified all of the information, we will provide you with a copy of your consumer report.

Sincerely,

Microbilt Consumer Affairs Department

Microbilt, P.O. Box 440693, Kennesaw, GA 30160

Report Request Form

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