P.O. Box 105788
Atlanta, GA 30348

Dear Equifax:

I would like to place a security freeze on my credit file. My name is

My current address is


My former address was


My Social Security number is and my date of birth is

Circle one:
I am an identity theft victim and I enclose a copy of my police report or DMV investigative report.

I will pay the fee of $10 for placing the freeze by

Yours truly,