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Request for Information Under Freedom of Information Act

Complete the form fields below to generate a letter asking a company, organization or other entity to send you the information they have about you on record.

Click here for a sample. All information appearing in bold type are the form fields that are either automatically completed by the program or completed based on information you supplied in this form.

Your Full Name:

First Name	Middle Name
Last Name	Suffix(e.g., Jr.)

Address:

City:

State/Province:

(Select a state for U.S. clients or a Canadian province)

Zip/Postal Code:

Country:

Your Phone No.:

Company:

(Name of company or organization having the information on record)

Address:

City:

State/Province:

(Select a state for U.S. clients or a Canadian province)

Zip/Postal Code:

Country:

Contact Person's Name (if known):

(Select Mr./Mrs./Miss/Ms.)
(first name)		(last name)

Other Names By Which You Are Known:

(List all other names by which you are known, if any. Press <ENTER> twice to enter a new name.)

Your SS #:

(Your Social Security Number)

Address of Record:

(old street address)
(old city)
(old state)	(old zip/postal code)
(old country)

(Enter the address this company or entity has on record if different than your current address.)

This is not a substitute for legal advice and it is suggested that an attorney be consulted.

Request for Information Under Freedom of Information Act

Enter Your New Location:

(e.g., San Diego, CA or 92121 or 619)