701 Experian Parkway
P.O. Box 9554
Allen, TX 75013

Dear Experian:

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

My current address is

Below is a list of my addresses for the past five years:


My Social Security number is:

and my date of birth is:

As proof of my address, I am enclosing the following two items:


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,