Premium Signature Form

Dear Disclosure Officer – I am writing to request that CoreLogic SafeRent please provide a consumer report disclosure to me by postal mail. Where available, the company’s response must include all information in the file, including sources and disclosures. My information is provided below; you may contact me directly to confirm my identity.

The Fair Credit Reporting Act (FCRA) stipulates that a nationwide specialty consumer reporting agency, “shall make all disclosures…once during any twelve month period upon request of the consumer and without charge to the consumer.” In addition, “nationwide specialty consumer reporting agencies may furnish a consumer report in accordance with the written instructions of the consumer to whom it relates.” (

In addition, all nationwide specialty consumer reporting agencies, “must provide a toll-free number that is published in every telephone directory in which a number for the company appears, and is clearly and prominently posted on the company’s website. In addition, federal law requires the company to have clear and easy instructions for consumers to get these reports, and adequate staff in place or means to deal with consumers’ requests.” (

Section I – Primary Identification Information

Section II – Supplemental Information – Other Names

Please list all other names that would have been given to any related company in the last seven years. This additional information may assist in the identification of records, should there be any records with similar identifiers. Please write NO or NA if this is not applicable. 


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Signature Certificate
Document name: Premium Signature Form
Unique Document ID: af2df12f1fd255aa70f19b8504a54d4b64bf8c6c
Timestamp Audit
2016-03-28 02:13:36 EDTPremium Signature Form Uploaded by Ben Gurion - IP