consumer.risk.lexisnexis.com
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https://consumer.risk.lexisnexis.com/request
Submission: On March 18 via manual from US — Scanned from DE
Submission: On March 18 via manual from US — Scanned from DE
Form analysis 1 forms found in the DOM
POST /requestSubmit
<form method="post" action="/requestSubmit" role="request" id="request-report">
<div class="">
<p>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. You can
submit questions and/or documents to us via our LexisNexis Risk Solutions Reports <a href="/help">Help page</a>. If you need to speak to a live LexisNexis Risk Solutions Consumer Center representative, please call 1-888-497-0011.</p>
<p>To submit a request, you are required to provide your First Name, Last Name, Street Address, City, Zip, and Date of Birth. Depending on the type of request you may also be required to provide either your Social Security Number or Your Driver’s
License Number and State. The information that you provide will only be used by LexisNexis Risk Solutions to verify your identity and to process your request. Your information will not be given or sold to any other company. We may not be able
to comply with your request if we are unable to confirm your identity or to connect the information you submit in your request with personal information in our possession.</p>
<p>For more information on submitting a request using this secure form view the <a href="/img/Online_Request_Form_Instructions.pdf" target="_blank" rel="noopener">Online Request Form Instructions <em class="far fa-file-pdf"></em></a>.</p>
<p>Please complete all of the sections on the form so that we may properly process your request. If we are unable to process your request, we will notify you via U.S. Mail.</p>
<p><em><span style="color:red">*</span>required <span style="color:red">⁺</span>At least one is required</em></p>
<div class="form-row">
<input type="hidden" id="tmxID" name="tmxID" value="cd1710772608_ia5efvm9c3qe8pi0nov4s4vjoq">
<input type="hidden" id="ReferState" name="ReferState">
<div class="form-group col-md-3">
<label class="input required">
<span class="input-label">First Name</span>
<input id="FirstName" name="FirstName" class="input-field form-control required" type="text" placeholder="First Name" required="">
</label>
</div>
<div class="form-group col-md-3">
<label class="input">
<span class="input-label">Middle Name</span>
<input id="MiddleName" name="MiddleName" class="input-field form-control" type="text" placeholder="Middle Name">
</label>
</div>
<div class="form-group col-md-3">
<label class="input required">
<span class="input-label">Last Name</span>
<input id="LastName" name="LastName" class="input-field form-control" type="text" placeholder="Last Name" required="">
</label>
</div>
<div class="form-group col-md-3">
<label class="input select-placeholder">
<span class="input-label">Suffix</span>
<select name="Suffix" id="Suffix" class="input-field form-control select-placeholder-input">
<option value="" selected="selected">Suffix</option>
<option value="1">Jr</option>
<option value="2">Sr</option>
<option value="3">II</option>
<option value="4">III</option>
<option value="5">IV</option>
</select>
</label>
</div>
</div>
<h3>Resident Address</h3>
<div class="form-row">
<div class="form-group col-md-4">
<label class="input required">
<span class="input-label">Street Address</span>
<input id="Residence_StreetAddress1" name="Residence_StreetAddress1" class="input-field form-control" type="text" placeholder="Street Address" required="">
</label>
</div>
<div class="form-group col-md-3">
<label class="input required">
<span class="input-label">City</span>
<input id="Residence_City" name="Residence_City" class="input-field form-control" type="text" placeholder="City" required="">
</label>
</div>
<div class="form-group col-md-3">
<label class="input select-placeholder required">
<span class="input-label">State</span>
<select name="Residence_State" id="Residence_State" class="input-field state-field form-control select-placeholder-input" required="">
<option value="" selected="selected">Select a State</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DC">DC</option>
<option value="DE">Delaware</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</label>
</div>
<div class="form-group col-md-2">
<label class="input required">
<span class="input-label">Zip</span>
<input id="Residence_Zip5" name="Residence_Zip5" class="input-field form-control Zip5" type="text" pattern="[0-9]{5}" maxlength="5" placeholder="Zip" required="">
</label>
</div>
</div>
<!--end address section-->
<label class="res_address" for="res_address">
<input id="res_address" type="checkbox" name="res_address"> My Delivery Address is Not the Same as My Resident Address </label>
<div class="mailing-address hidden">
<h3>Delivery Address (Mailing Address)</h3>
<div class="form-row">
<div class="form-group col-md-4">
<label class="input">
<span class="input-label">Street Address</span>
<input id="Mailing_StreetAddress1" name="Mailing_StreetAddress1" class="input-field form-control" type="text" placeholder="Street Address*">
</label>
</div>
<div class="form-group col-md-3">
<label class="input">
<span class="input-label">City</span>
<input id="Mailing_City" name="Mailing_City" class="input-field form-control" type="text" placeholder="City*">
</label>
</div>
<div class="form-group col-md-3">
<label class="input select-placeholder">
<span class="input-label">State</span>
<!--<input id="State" name="State" class="input-field form-control" type="text" placeholder="State">-->
<select name="Mailing_State" id="Mailing_State" class="input-field state-field form-control select-placeholder-input">
<option value="" selected="selected">Select a State*</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DC">DC</option>
<option value="DE">Delaware</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</label>
</div>
<div class="form-group col-md-2">
<label class="input">
<span class="input-label">Zip</span>
<input id="Mailing_Zip5" name="Mailing_Zip5" class="input-field form-control Zip" type="text" pattern="[0-9]{5}" maxlength="5" placeholder="Zip*">
</label>
</div>
</div>
<!--end address section-->
</div>
<div class="form-row">
<div class="form-group col-md-10">
<h3>Request and Receive Your Consumer Disclosure Report Online</h3>
<p class="standard-options NV-options">Select the Request Your Consumer Disclosure Report checkbox below to submit an online request to access your file and learn more about the personal information LexisNexis Risk Solutions maintains about
you in accordance with the Fair Credit Reporting Act.</p>
<p class="CA-options state-options hidden">Select the Request Your Consumer Disclosure Report checkbox below to request a copy of your information. California residents will receive both their LexisNexis® Risk Solutions Consumer Disclosure
Report pertaining to the Fair Credit Reporting Act and their California Consumer State Privacy Act Report pertaining to the California Privacy Laws.</p>
<p class="CO-options state-options hidden">Select the Request Your Consumer Disclosure Report checkbox below to request a copy of your information. As a Colorado resident, you will receive a LexisNexis® Risk Solutions Consumer Disclosure
Report (pertaining to the Fair Credit Reporting Act), and a State Privacy Act Report (pertaining to the Colorado Privacy Act).</p>
<p class="CT-options state-options hidden">Select the Request Your Consumer Disclosure Report checkbox below to request a copy of your information. As a Connecticut resident, you will receive a LexisNexis® Risk Solutions Consumer Disclosure
Report (pertaining to the Fair Credit Reporting Act), and a State Privacy Act Report (pertaining to the Connecticut Data Privacy Act (CTDPA).</p>
<p class="UT-options state-options hidden">Select the Request Your Consumer Disclosure Report checkbox below to request a copy of your information. Utah residents will receive both their LexisNexis® Risk Solutions Consumer Disclosure Report
pertaining to the Fair Credit Reporting Act and their Privacy Act Report pertaining to the Utah Consumer Privacy Act (UCPA).</p>
<p class="VA-options state-options hidden">Select the Request Your Consumer Disclosure Report checkbox below to request a copy of your information. Virginia residents will receive both their LexisNexis® Risk Solutions Consumer Disclosure
Report pertaining to the Fair Credit Reporting Act and their Privacy Act Report pertaining to the Virginia Consumer Data Protection Act.</p>
<label class="orderConsumerDisclosureReport" for="orderConsumerDisclosureReport">
<input id="orderConsumerDisclosureReport" type="checkbox"
name="orderConsumerDisclosureReport"><b><span class="standard-options NV-options CA-options CO-options CT-options VA-options UT-options "> Request Your Consumer Disclosure Report</span></b>
</label>
<br>
<br>
<p class="NV-options state-options hidden">Once we have verified and processed your report request, you will receive a letter via U.S. Mail with additional information explaining how to access your report online.</p>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-10">
<h3>Request a Description of Procedure Letter</h3>
<p>Select the Request a Description of Procedure Letter checkbox below to receive a letter from LexisNexis that is personal to your dispute request(s) and describes how we process dispute(s) that you may have in the system.</p>
<label class="orderDescriptionOfProcessLetter" for="orderDescriptionOfProcessLetter">
<input id="orderDescriptionOfProcessLetter" type="checkbox" name="orderDescriptionOfProcessLetter"> <b>Request a Description of Procedure Letter</b>
</label>
<br>
<br>
<h3 class="CA-options state-options hidden">Additional Options for California Residents</h3>
<p class="CA-options state-options hidden">As a California resident, you have additional options under the California Privacy Laws:</p>
<h3 class="CO-options state-options hidden">Additional Options for Colorado Residents</h3>
<p class="CO-options state-options hidden">As a Colorado resident, you have additional options under the Colorado Privacy Act (CPA):</p>
<h3 class="CT-options state-options hidden">Additional Options for Connecticut Residents</h3>
<p class="CT-options state-options hidden">As a Connecticut resident, you have additional options under the CTDPA:</p>
<h3 class="VA-options state-options hidden">Additional Options for Virginia Residents</h3>
<p class="VA-options state-options hidden">As a Virginia resident, you have additional options under the Virginia Consumer Data Protection Act (VCDPA):</p>
<h3 class="UT-options state-options hidden">Additional Options for Utah Residents</h3>
<p class="UT-options state-options hidden">As a Utah resident, you have additional options under the Utah Privacy Act (UCPA):</p>
<h3 class="NV-options state-options hidden">Additional Options for Nevada Residents</h3>
<p class="NV-options state-options hidden">As a Nevada resident, you have opt-out options that you can request under the Nevada Privacy Law:</p>
</div>
</div>
<div>
<div class="form-row state-privacy hidden">
<div class="form-group col-md-10">
<p class="state-options CA-options small">
<b>Notice of Right to Opt-Out of Sale/Sharing:</b> A <b>Do Not Sell or Share My Personal Information</b> request, sometimes referred to as an opt-out request, will restrict your personal information that is subject to the California
Privacy Laws from being sold to a third party and from sharing such personal information for cross-context behavioral advertising if applicable. Our products and services are not linked to tracking technologies utilized through our
websites for cross-context behavioral advertising, and we do not share personal information in our products and services for cross-context behavioral advertising. A <b>Full Opt-Out</b> request will restrict your personal information from
being sold to a third party subject to certain exceptions. A <b>Partial Opt-Out</b> request will opt-out your personal information we maintain that is subject to the California Privacy Laws except for any data we have relative to your
occupation or profession, which will continue to be sold to third parties. In any case, an opt-out request will not apply to information that is exempt from the requirements of the California Privacy Laws. If you have previously opted out
but instead want to authorize your personal information to be sold, you may submit an Opt-In request. For more information, or for additional methods to submit an opt-out request, see our <a href="california">California Privacy</a> page.
</p>
<p class="state-options CA-options small"> When you visit our websites, we sometimes use tracking technologies which may be considered "sharing" of your personal information for cross-context behavioral advertising. You may request to
opt-out of such tracking technologies by utilizing the "Cookie Settings" link on our websites that use tracking technologies for cross-context behavioral advertising or by sending an opt-out preference signal supported by your device or
browser. Your use of an opt-out preference signal will apply only to your device or browser and not to other consumer information that is not linked to your device or browser. Please note this Consumer Portal website does not use tracking
technologies for cross-context behavioral advertising.</p>
<p class="state-options CA-options small"><b>Notice of Right to Limit the Use of My Sensitive Personal Information:</b> A Limit the Use of My Sensitive Personal Information request will prevent your sensitive personal information that is
subject to the requirements of the California Privacy Laws from being used or disclosed, subject to certain exceptions provided by law. A <b>Limit Use</b> request will limit the use and disclosure of your sensitive personal information
subject to certain exceptions. </p>
<p class="state-options CO-options small">
<b>Notice of Right to Opt-Out of Sale/Sharing</b>: A <b>Do Not Sell or Share My Personal Information</b> request, sometimes referred to as an opt-out request, will restrict your personal information that is subject to the requirements of
the CPA from being processed for purposes of (i) targeted advertising, (ii) the sale of personal data, and (iii) profiling in furtherance of decisions that produce legal or similarly significant effects concerning you, if applicable. Our
products and services are not linked to tracking technologies utilized through our websites for targeted advertising, and we do not sell personal information in our products and services for targeted advertising online. A
<b>Full Opt-Out</b> request will opt-out your personal information from being sold to a third party or used for such profiling subject to certain exceptions. A <b>Partial Opt-Out</b> request will opt-out all your personal information we
maintain that is subject to the CPA except for any data we have relative to your occupation or profession, which will continue to be sold to third parties. In any case, an opt-out request will not apply to information that is exempt from
the requirements of the CPA. If you have previously opted out but instead want to authorize your personal information to be sold, you may submit an <b>Opt-In</b> request. For more information, or for additional methods to submit an
opt-out request, see our <a href="/colorado ">Colorado Privacy</a> page.
</p>
<p class="state-options CT-options small">
<b>Notice of Right to Opt-Out of Sale/Sharing</b>: A <b>Do Not Sell or Share My Personal Information</b> request, sometimes referred to as an opt-out request, will restrict your personal information that is subject to the requirements of
the CTDPA from being processed for purposes of (i) targeted advertising, (ii) the sale of personal data, and (iii) profiling in furtherance of decisions that produce legal or similarly significant effects concerning you, if applicable.
Our products and services are not linked to tracking technologies utilized through our websites for targeted advertising, and we do not sell personal information in our products and services for targeted advertising online. A
<b>Full Opt-Out</b> request will opt-out your personal information from being sold to a third party or used for such profiling subject to certain exceptions. A <b>Partial Opt-Out</b> request will opt-out all your personal information we
maintain that is subject to the CTDPA except for any data we have relative to your occupation or profession, which will continue to be sold to third parties. In any case, an opt-out request will not apply to information that is exempt
from the requirements of the CTDPA. If you have previously opted out but instead want to authorize your personal information to be sold, you may submit an <b>Opt-In</b> request. For more information, or for additional methods to submit an
opt-out request, see our <a href="/connecticut">Connecticut Privacy</a> page.
</p>
<p class="state-options UT-options small">
<b>Notice of Right to Opt-Out of Sale/Sharing</b>: A <b>Do Not Sell or Share My Personal Information</b> request, sometimes referred to as an opt-out request, will restrict your personal information that is subject to the requirements of
the UCPA from being processed for purposes of (i) targeted advertising, and (ii) the sale of personal data, as applicable. Our products and services are not linked to tracking technologies utilized through our websites for targeted
advertising, and we do not sell personal information in our products and services for targeted advertising online.
</p>
<p class="state-options UT-options small"> A <b>Full Opt-Out</b> request will opt-out your personal information from being sold to a third party subject to certain exceptions. A <b>Partial Opt-Out</b> request will opt-out all your personal
information we maintain that is subject to the UCPA except for any data we have relative to your occupation or profession, which will continue to be sold to third parties. In any case, an opt-out request will not apply to information that
is exempt from the requirements of the UCPA. If you have previously opted out but instead want to authorize your personal information to be sold, you may submit an <b>Opt-In</b> request. For more information, or for additional methods to
submit an opt-out request, see our <a href="/utah">Utah Privacy</a> page.</p>
<p class="state-options VA-options small">
<b>Notice of Right to Opt-Out of Sale/Sharing</b>: A <b>Do Not Sell or Share My Personal Information</b> request, sometimes referred to as an opt-out request, will restrict your personal information that is subject to the requirements of
the VCDPA from being processed for purposes of (i) targeted advertising, (ii) the sale of personal data, and (iii) profiling in furtherance of decisions that produce legal or similarly significant effects concerning you, if applicable.
Our products and services are not linked to tracking technologies utilized through our websites for targeted advertising, and we do not sell personal information in our products and services for targeted advertising online. A
<b>Full Opt-Out</b> request will opt-out your personal information from being sold to a third party or used for such profiling subject to certain exceptions. A <b>Partial Opt-Out</b> request will opt-out all your personal information we
maintain that is subject to the VCDPA except for any data we have relative to your occupation or profession, which will continue to be sold to third parties. In any case, an opt-out request will not apply to information that is exempt
from the requirements of the VCDPA. If you have previously opted out but instead want to authorize your personal information to be sold, you may submit an <b>Opt-In</b> request. For more information, or for additional methods to submit an
opt-out request, see our <a href="/virginia">Virginia Privacy</a> page.
</p>
<p class="state-options CO-options CT-options VA-options UT-options small"> When you visit our websites, we sometimes use tracking technologies which may be considered a "sale" of your personal information for targeted advertising. You may
request to opt-out of such tracking technologies by utilizing the "Cookie Settings" link on our websites that use tracking technologies for targeted advertising or by sending an opt-out preference signal supported by your device or
browser. Your use of an opt-out preference signal will apply only to your device or browser and not to other consumer information that is not linked to your device or browser. Please note this Consumer Portal website does not use tracking
technologies for targeted advertising. </p>
<p class="state-options NV-options small"><b>Notice of Right to Opt-Out:</b> A Do Not Sell My Personal Information request, sometimes referred to as an opt-out request, will prevent your personal information from being sold to a third
party. If you have previously opted-out but instead want to authorize your personal information to be sold, you may submit an opt-in request. For more information, or how to submit an opt-out or opt-in request, see the
<a href="/nevada" target="_blank">Nevada Privacy Rights</a> page.</p>
<label class="globalOptoutFlag" for="globalOptoutFlag">
<input id="globalOptoutFlag" class="globalOptoutFlag" type="radio" name="opts" value="globalOptoutFlag">
<b><span class="hidden state-options CA-options VA-options UT-options CO-options CT-options">Full </span>Opt-Out:</b> Do Not Sell <span class="hidden state-options CA-options VA-options UT-options CO-options CT-options">or Share</span>
My Personal Information </label>
<br>
<label for="LimitUse" class="limit-use hidden state-options CA-options"><input id="LimitUse" class="limit-use hidden state-options CA-options" type="checkbox" name="limitUseGlobalOptoutFlag">Limit the Use of My Sensitive Personal
Information</label>
<label class="partialOptoutFlag state-options CA-options VA-options UT-options CO-options CT-options" for="partialOptoutFlag">
<input id="partialOptoutFlag" class="partialOptoutFlag" type="radio" name="opts" value="partialOptoutFlag"> <b>Partial Opt-Out:</b> Allow for the Sale of My Professional Information but otherwise Do Not Sell My Personal Information
</label>
<br class="state-options CA-options VA-options UT-options CO-options CT-options">
<label class="opt-in" for="opt-in">
<input id="opt-in" class="opt-in" type="radio" name="opts" value="optIn"> <b>Opt-In:</b> Allow for the Sale of My Personal Information </label>
<br>
<div class="card opt-in-warn hidden">
<div class="card-header"> Opt-In Request </div>
<div class="card-body">
<div class="card-text">
<p>
<input id="OptInAck" class="OptInAck" type="checkbox" name="OptInAck"> I understand that by selecting the Opt-In (Allow for the Sale of My Personal Information) option I am allowing my personal information, that is maintained by
LexisNexis Risk Solutions, to be sold to third parties.
</p>
</div>
</div>
</div>
<br>
<label class="deleteMyPersonalInfo state-options CA-options VA-options UT-options CO-options CT-options" for="deleteMyPersonalInfo">
<input id="deleteMyPersonalInfo" class="deleteMyPersonalInfo" type="checkbox" name="deleteMyPersonalInfo"> <b>Delete My Personal Information</b>
</label>
<p class="state-options CA-options VA-options UT-options CO-options CT-options hidden">See more information on how
<a href="/img/State_Use_of_Individual_and_Professional_Information.pdf">LexisNexis uses your individual and professional information</a>.</p>
<br>
<br>
</div>
</div>
<div>
<div class="form-row">
<div class="form-group col-md-4">
<label class="input">
<span class="input-label">Email</span>
<input id="Email" name="Email" class="input-field form-control" type="email" placeholder="Email">
</label>
</div>
<div class="form-group col-md-4">
<p class="small" style="padding-top:7px;">Email is optional but must be provided and verified to include email-linked data in your report.</p>
</div>
</div>
<div class="form-row">
<div class="form-group col-md-3 ssndln">
<label class="input onerequired">
<span class="input-label">SSN</span>
<input id="SSN" name="SSN" class="input-field form-control SSN" type="text" placeholder="SSN">
</label>
</div>
<div class="form-group col-md-3">
<label class="input">
<span class="input-label">Phone</span>
<input id="Phone" name="Phone" class="input-field form-control Phone" type="tel" placeholder="Phone">
</label>
</div>
<div class="form-group col-md-3">
<label class="input col-xs-2 has-input select-placeholder required">
<span class="input-label">Date of Birth</span>
<input id="DOB" name="DOB" class="input-field form-control DOB select-placeholder-input" type="text" placeholder="mm / dd / yyyy" required="">
</label>
</div>
</div>
<div class="card minor-notice hidden">
<div class="card-header"> Minor Information Notice </div>
<div class="card-body">
<div class="card-text">
<p>You will need to submit support paperwork before you can successfully request a report for a minor.</p>
<p>Please call to speak to a live Consumer Center representative at 1-866-897-8126.</p>
<p>You can also <a class="external-link" rel="nofollow" title="https://personalreports.custhelp.com/app/ask" href="https://personalreports.custhelp.com/app/ask">submit a question online.
</a>
</p>
<p>Our Consumer Center operates Monday – Friday 8 AM to 7PM EST.</p>
</div>
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<div class="form-row ssndln">
<div class="form-group col-md-6">
<label class="input onerequired">
<span class="input-label">Driver's License Number</span>
<input id="DLNumber" name="DLNumber" class="input-field form-control" type="text" placeholder="Driver's License Number">
</label>
</div>
<div class="form-group col-md-6">
<label class="input select-placeholder">
<span class="input-label">Driver's License State</span>
<select name="Issuer" id="State" class="input-field form-control select-placeholder-input">
<option value="" selected="selected">Select a Driver's License State</option>
<option value="AL">Alabama</option>
<option value="AK">Alaska</option>
<option value="AZ">Arizona</option>
<option value="AR">Arkansas</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DC">DC</option>
<option value="DE">Delaware</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="HI">Hawaii</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="IA">Iowa</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="ME">Maine</option>
<option value="MD">Maryland</option>
<option value="MA">Massachusetts</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MS">Mississippi</option>
<option value="MO">Missouri</option>
<option value="MT">Montana</option>
<option value="NE">Nebraska</option>
<option value="NV">Nevada</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NY">New York</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VT">Vermont</option>
<option value="VA">Virginia</option>
<option value="WA">Washington</option>
<option value="WV">West Virginia</option>
<option value="WI">Wisconsin</option>
<option value="WY">Wyoming</option>
</select>
</label>
</div>
</div>
<p class="small state-privacy-message state-privacy hidden">Your Social Security Number or your Driver’s License Number and State are not required to submit an Opt-Out or Opt-In request. However, either your Social Security Number or your
Driver’s License Number and State are required to provide a copy of your information<span class="hidden state-options CA-options"> or in support of a deletion request</span>.</p>
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<button type="submit" class="btn btn-lg btn-primary confirm-button">Submit Request</button>
<div id="tinyspin">
<div class="message"></div>
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</form>Text Content
"> * Homepage * LexisNexis® Consumer Disclosure * Your Privacy Rights * FACT Act * Security Freeze * Your FCRA Rights * Help CONSUMER PORTAL ONLINE 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. You can submit questions and/or documents to us via our LexisNexis Risk Solutions Reports Help page. If you need to speak to a live LexisNexis Risk Solutions Consumer Center representative, please call 1-888-497-0011. To submit a request, you are required to provide your First Name, Last Name, Street Address, City, Zip, and Date of Birth. Depending on the type of request you may also be required to provide either your Social Security Number or Your Driver’s License Number and State. The information that you provide will only be used by LexisNexis Risk Solutions to verify your identity and to process your request. Your information will not be given or sold to any other company. We may not be able to comply with your request if we are unable to confirm your identity or to connect the information you submit in your request with personal information in our possession. For more information on submitting a request using this secure form view the Online Request Form Instructions . Please complete all of the sections on the form so that we may properly process your request. If we are unable to process your request, we will notify you via U.S. Mail. *required ⁺At least one is required First Name Middle Name Last Name Suffix Suffix Jr Sr II III IV RESIDENT ADDRESS Street Address City State Select a State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDCDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip My Delivery Address is Not the Same as My Resident Address DELIVERY ADDRESS (MAILING ADDRESS) Street Address City State Select a State* AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDCDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip REQUEST AND RECEIVE YOUR CONSUMER DISCLOSURE REPORT ONLINE Select the Request Your Consumer Disclosure Report checkbox below to submit an online request to access your file and learn more about the personal information LexisNexis Risk Solutions maintains about you in accordance with the Fair Credit Reporting Act. Select the Request Your Consumer Disclosure Report checkbox below to request a copy of your information. California residents will receive both their LexisNexis® Risk Solutions Consumer Disclosure Report pertaining to the Fair Credit Reporting Act and their California Consumer State Privacy Act Report pertaining to the California Privacy Laws. Select the Request Your Consumer Disclosure Report checkbox below to request a copy of your information. As a Colorado resident, you will receive a LexisNexis® Risk Solutions Consumer Disclosure Report (pertaining to the Fair Credit Reporting Act), and a State Privacy Act Report (pertaining to the Colorado Privacy Act). Select the Request Your Consumer Disclosure Report checkbox below to request a copy of your information. As a Connecticut resident, you will receive a LexisNexis® Risk Solutions Consumer Disclosure Report (pertaining to the Fair Credit Reporting Act), and a State Privacy Act Report (pertaining to the Connecticut Data Privacy Act (CTDPA). Select the Request Your Consumer Disclosure Report checkbox below to request a copy of your information. Utah residents will receive both their LexisNexis® Risk Solutions Consumer Disclosure Report pertaining to the Fair Credit Reporting Act and their Privacy Act Report pertaining to the Utah Consumer Privacy Act (UCPA). Select the Request Your Consumer Disclosure Report checkbox below to request a copy of your information. Virginia residents will receive both their LexisNexis® Risk Solutions Consumer Disclosure Report pertaining to the Fair Credit Reporting Act and their Privacy Act Report pertaining to the Virginia Consumer Data Protection Act. Request Your Consumer Disclosure Report Once we have verified and processed your report request, you will receive a letter via U.S. Mail with additional information explaining how to access your report online. REQUEST A DESCRIPTION OF PROCEDURE LETTER Select the Request a Description of Procedure Letter checkbox below to receive a letter from LexisNexis that is personal to your dispute request(s) and describes how we process dispute(s) that you may have in the system. Request a Description of Procedure Letter ADDITIONAL OPTIONS FOR CALIFORNIA RESIDENTS As a California resident, you have additional options under the California Privacy Laws: ADDITIONAL OPTIONS FOR COLORADO RESIDENTS As a Colorado resident, you have additional options under the Colorado Privacy Act (CPA): ADDITIONAL OPTIONS FOR CONNECTICUT RESIDENTS As a Connecticut resident, you have additional options under the CTDPA: ADDITIONAL OPTIONS FOR VIRGINIA RESIDENTS As a Virginia resident, you have additional options under the Virginia Consumer Data Protection Act (VCDPA): ADDITIONAL OPTIONS FOR UTAH RESIDENTS As a Utah resident, you have additional options under the Utah Privacy Act (UCPA): ADDITIONAL OPTIONS FOR NEVADA RESIDENTS As a Nevada resident, you have opt-out options that you can request under the Nevada Privacy Law: Notice of Right to Opt-Out of Sale/Sharing: A Do Not Sell or Share My Personal Information request, sometimes referred to as an opt-out request, will restrict your personal information that is subject to the California Privacy Laws from being sold to a third party and from sharing such personal information for cross-context behavioral advertising if applicable. Our products and services are not linked to tracking technologies utilized through our websites for cross-context behavioral advertising, and we do not share personal information in our products and services for cross-context behavioral advertising. A Full Opt-Out request will restrict your personal information from being sold to a third party subject to certain exceptions. A Partial Opt-Out request will opt-out your personal information we maintain that is subject to the California Privacy Laws except for any data we have relative to your occupation or profession, which will continue to be sold to third parties. In any case, an opt-out request will not apply to information that is exempt from the requirements of the California Privacy Laws. If you have previously opted out but instead want to authorize your personal information to be sold, you may submit an Opt-In request. For more information, or for additional methods to submit an opt-out request, see our California Privacy page. When you visit our websites, we sometimes use tracking technologies which may be considered "sharing" of your personal information for cross-context behavioral advertising. You may request to opt-out of such tracking technologies by utilizing the "Cookie Settings" link on our websites that use tracking technologies for cross-context behavioral advertising or by sending an opt-out preference signal supported by your device or browser. Your use of an opt-out preference signal will apply only to your device or browser and not to other consumer information that is not linked to your device or browser. Please note this Consumer Portal website does not use tracking technologies for cross-context behavioral advertising. Notice of Right to Limit the Use of My Sensitive Personal Information: A Limit the Use of My Sensitive Personal Information request will prevent your sensitive personal information that is subject to the requirements of the California Privacy Laws from being used or disclosed, subject to certain exceptions provided by law. A Limit Use request will limit the use and disclosure of your sensitive personal information subject to certain exceptions. Notice of Right to Opt-Out of Sale/Sharing: A Do Not Sell or Share My Personal Information request, sometimes referred to as an opt-out request, will restrict your personal information that is subject to the requirements of the CPA from being processed for purposes of (i) targeted advertising, (ii) the sale of personal data, and (iii) profiling in furtherance of decisions that produce legal or similarly significant effects concerning you, if applicable. Our products and services are not linked to tracking technologies utilized through our websites for targeted advertising, and we do not sell personal information in our products and services for targeted advertising online. A Full Opt-Out request will opt-out your personal information from being sold to a third party or used for such profiling subject to certain exceptions. A Partial Opt-Out request will opt-out all your personal information we maintain that is subject to the CPA except for any data we have relative to your occupation or profession, which will continue to be sold to third parties. In any case, an opt-out request will not apply to information that is exempt from the requirements of the CPA. If you have previously opted out but instead want to authorize your personal information to be sold, you may submit an Opt-In request. For more information, or for additional methods to submit an opt-out request, see our Colorado Privacy page. Notice of Right to Opt-Out of Sale/Sharing: A Do Not Sell or Share My Personal Information request, sometimes referred to as an opt-out request, will restrict your personal information that is subject to the requirements of the CTDPA from being processed for purposes of (i) targeted advertising, (ii) the sale of personal data, and (iii) profiling in furtherance of decisions that produce legal or similarly significant effects concerning you, if applicable. Our products and services are not linked to tracking technologies utilized through our websites for targeted advertising, and we do not sell personal information in our products and services for targeted advertising online. A Full Opt-Out request will opt-out your personal information from being sold to a third party or used for such profiling subject to certain exceptions. A Partial Opt-Out request will opt-out all your personal information we maintain that is subject to the CTDPA except for any data we have relative to your occupation or profession, which will continue to be sold to third parties. In any case, an opt-out request will not apply to information that is exempt from the requirements of the CTDPA. If you have previously opted out but instead want to authorize your personal information to be sold, you may submit an Opt-In request. For more information, or for additional methods to submit an opt-out request, see our Connecticut Privacy page. Notice of Right to Opt-Out of Sale/Sharing: A Do Not Sell or Share My Personal Information request, sometimes referred to as an opt-out request, will restrict your personal information that is subject to the requirements of the UCPA from being processed for purposes of (i) targeted advertising, and (ii) the sale of personal data, as applicable. Our products and services are not linked to tracking technologies utilized through our websites for targeted advertising, and we do not sell personal information in our products and services for targeted advertising online. A Full Opt-Out request will opt-out your personal information from being sold to a third party subject to certain exceptions. A Partial Opt-Out request will opt-out all your personal information we maintain that is subject to the UCPA except for any data we have relative to your occupation or profession, which will continue to be sold to third parties. In any case, an opt-out request will not apply to information that is exempt from the requirements of the UCPA. If you have previously opted out but instead want to authorize your personal information to be sold, you may submit an Opt-In request. For more information, or for additional methods to submit an opt-out request, see our Utah Privacy page. Notice of Right to Opt-Out of Sale/Sharing: A Do Not Sell or Share My Personal Information request, sometimes referred to as an opt-out request, will restrict your personal information that is subject to the requirements of the VCDPA from being processed for purposes of (i) targeted advertising, (ii) the sale of personal data, and (iii) profiling in furtherance of decisions that produce legal or similarly significant effects concerning you, if applicable. Our products and services are not linked to tracking technologies utilized through our websites for targeted advertising, and we do not sell personal information in our products and services for targeted advertising online. A Full Opt-Out request will opt-out your personal information from being sold to a third party or used for such profiling subject to certain exceptions. A Partial Opt-Out request will opt-out all your personal information we maintain that is subject to the VCDPA except for any data we have relative to your occupation or profession, which will continue to be sold to third parties. In any case, an opt-out request will not apply to information that is exempt from the requirements of the VCDPA. If you have previously opted out but instead want to authorize your personal information to be sold, you may submit an Opt-In request. For more information, or for additional methods to submit an opt-out request, see our Virginia Privacy page. When you visit our websites, we sometimes use tracking technologies which may be considered a "sale" of your personal information for targeted advertising. You may request to opt-out of such tracking technologies by utilizing the "Cookie Settings" link on our websites that use tracking technologies for targeted advertising or by sending an opt-out preference signal supported by your device or browser. Your use of an opt-out preference signal will apply only to your device or browser and not to other consumer information that is not linked to your device or browser. Please note this Consumer Portal website does not use tracking technologies for targeted advertising. Notice of Right to Opt-Out: A Do Not Sell My Personal Information request, sometimes referred to as an opt-out request, will prevent your personal information from being sold to a third party. If you have previously opted-out but instead want to authorize your personal information to be sold, you may submit an opt-in request. For more information, or how to submit an opt-out or opt-in request, see the Nevada Privacy Rights page. Full Opt-Out: Do Not Sell or Share My Personal Information Limit the Use of My Sensitive Personal Information Partial Opt-Out: Allow for the Sale of My Professional Information but otherwise Do Not Sell My Personal Information Opt-In: Allow for the Sale of My Personal Information Opt-In Request I understand that by selecting the Opt-In (Allow for the Sale of My Personal Information) option I am allowing my personal information, that is maintained by LexisNexis Risk Solutions, to be sold to third parties. Delete My Personal Information See more information on how LexisNexis uses your individual and professional information. Email Email is optional but must be provided and verified to include email-linked data in your report. SSN Phone Date of Birth Minor Information Notice You will need to submit support paperwork before you can successfully request a report for a minor. Please call to speak to a live Consumer Center representative at 1-866-897-8126. You can also submit a question online. Our Consumer Center operates Monday – Friday 8 AM to 7PM EST. Driver's License Number Driver's License State Select a Driver's License State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDCDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Your Social Security Number or your Driver’s License Number and State are not required to submit an Opt-Out or Opt-In request. However, either your Social Security Number or your Driver’s License Number and State are required to provide a copy of your information or in support of a deletion request. Submit Request ACKNOWLEDGMENT MESSAGE Your order has been received. You will receive a message via US Mail within the timeframe allowed by law. We will verify the information you provided with information in our records. We may not be able to comply with your request if we are unable to confirm your identity or to connect the information you submit in your request with personal information in our possession. -------------------------------------------------------------------------------- * Copyright © 2024 LexisNexis Risk Solutions. * About Us | * Terms & Conditions | * Privacy Policy | * Cookie Policy | * Site Map