Security Freeze Request Form

I would like to:

Request a security freeze
Temporarily lift an existing security freeze for the following time period:

	Date from:
	Date to:

Temporarily lift an existing security freeze for a specific credit grantor (grantor lift):

Grantor Name:

Permanently remove an existing security freeze

10-digit Freeze Confirmation Number (issued when we placed the freeze):

Please Note: this number is required, to lift or remove a security freeze

Your Identification Information:

First Name	MI	Last Name	Generation

Address

City	State	Zip

Social Security Number	Date of birth (MM/DD/YYYY)
– –	/ /
Home Phone	Business/alternate Phone	Ext.
– –	– –
Email Address

Mail this form to:

Innovis
Attn: Consumer Assistance
P.O. Box 1373
Columbus, OH 43216-1373

I would like to:

10-digit Freeze Confirmation Number (issued when we placed the freeze): Please Note: this number is required, to lift or remove a security freeze

Your Identification Information:

Mail this form to:

10-digit Freeze Confirmation Number (issued when we placed the freeze):

Please Note: this number is required, to lift or remove a security freeze