Consumer Request Form

Applicant Information

In order to assist you with your request, please complete the necessary information with as much detail as possible. Once completed, you can anticipate a customer support specialist to respond to you within 1 to 2 business days.

Name *

First

Middle

Last

Last 4 digits of SSN *

Date of Birth *

Current Address *

Address Line 1

Address Line 2

City

State

Zip Code

Driver's License Number (Optional)

How do you prefer to be contacted? *

Email
Telephone

Email *

Email

Confirm Email

Phone *

If available, please provide any file numbers.

Are you making this request for yourself or someone else? *

Myself
Someone Else

Requester Information

Requester's Name *

First

Last

Relationship to Applicant *

How do you prefer to be contacted? *

Email
Telephone

Requester's Email *

Email

Confirm Email

Requester's Phone *

Request Details

Type of Request *

Requesting a copy of my file
Ask question about communication received via email
Dispute information in my file
Other

What type of communication?

If Other, please describe: *

What search type(s) are you disputing? *

If Other, please describe: *

Provide any Case Numbers you have for the record(s) in dispute.

Do you have any additional documentation with regards to the disputed record(s)? (If Yes, this information will be requested when the AAIM Support Individual contacts you.) *

Yes
No

Please share any additional information that you feel would be helpful in resolving the disputed record(s).

To assist you better, please describe the issue(s) you are experiencing: