Experian National Consumer Assistance Center P.O. Box 2104 Allen, TX 75013-2104
Your full name (including generation, such as Jr., Sr., III)
Current address
City, state, zip
Your Social Security number
Your date of birth
If you've lived at this address less than five years, please list your previous addresses for a five-year period:
Previous address #1
Previous address #2
Spouse's first name (if married)
Your signature
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