Request to Submit a Statement*
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LexisNexis offers individuals the ability to submit a statement if their address or phone number appearing in Accurint for
Collections - Contact & Locate product should not be used to collect a specific debt. Should you elect to submit a
statement, the statement will be added to a database accessible by LexisNexis debt collection customers. You may
request a statement only on yourself, your minor child or on behalf of someone for whom you have power of attorney.
Please submit a separate request for each individual and complete all the appropriate items on the request form.
Please provide the following proof of identity along with your request.
STEP 1: Complete and submit the enclosed request form to the address provided. Please fill it out legibly and
completely. Any missing information may result in the inability to properly research our files.
STEP 2: You must submit additional identity and address verification documents. In order to verify your identity
and your address. The first document is for proof of identity. The second document is for proof of the
mailing address. Billing statements should be dated within the preceding two months. Select one
document from each category.
Please do not mail your original document. Only send a copy of your choice of document.
Category A:
Category B:
Identification Documents:
Driver’s License (not expired)
State Issued ID Card (not expired)
Social Security Card
Canadian Issued Driver’s License
(not expired)
Military Identification Cards
Passports
Proof of Mailing Address (must reference the Requestor’s Name and Mailing Address):
Driver’s License or Canadian Issued Driver’s License (not expired)
Major Credit Card Billing Statement*
Major Bank Statement*
Major Gas Company Credit Card Billing Statement*
Major Department Store Credit Card Billing Statement*
Utility Bill* (Gas, Electric, Water, Sewer, or Cable/Satellite-Dish)
Telephone Bill*
Major Cell Phone Service Provider Bill*
Insurance Declaration Page (must be in effect – not expired)
Please do not send your insurance card or insurance statement.
Property Tax Bill (for most current year or year immediately preceding)**
Property Deed**
Please do not send your Property Tax Receipt.
*Documents should be dated within the preceding two months.
** Submit this ADDITIONAL document if information requested is for a second home or
rental property and not your primary mailing address
For MINOR child: The proof of Identity (Category A) MUST include the minor’s Social Security Card and a document that
shows the requesting adult (i.e., parent or guardian) and minor’s name from one of the three types of documents: Birth
Certificate, Legal Guardianship or Immunization Record. Proof of Mailing Address (Category B) would be documentation
with the requestor’s name as denoted above.
In the Case of a Power of Attorney: The proof of Identity (Category A) MUST include the subject consumer’s Social
Security Card and a document that shows the requesting adult has Power of Attorney over such consumer. You will also
need to provide proof of mailing address (Category B) for the requesting adult with Power of Attorney
STEP 3: Your request may be mailed, faxed or emailed to the LexisNexis Consumer Center.
FAX: 866-414-4436
Email: Contact us via email at our website https://consumer-solutions.custhelp.com (select “ask a question”)
Mail:
LexisNexis Risk Solutions FL Inc.
Attn: Contact & Locate Inquiry
P.O. Box 105610
Atlanta, GA 30348-5610
Once we have received your completed Statement Request Form and verification documents, it will take approximately 5
days to process your request.
*LexisNexis reserves the right to limit statements to 100 words
Statement Submission Form
(The statement will be added to a database accessibly by LexisNexis debt collection customers)
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Address or Phone Number to which the
statement should be added:
Text of Statement*
Address:
Phone #:
__________-________-_____________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
Date:
Signature:
_______\_______\__________
______________________________________________________________________
*LexisNexis reserves the right to limit statements to 100 words
Before submitting, please check to ensure you have fully completed and signed the request form.
To avoid delay, please provide all information requested.
Submit the completed request form, identification and address verification documents to the mailing address
on the first page.
Full Name (First, Middle, Family/Surname, Suffix)
Date of Birth (month/day/year)
Phone Number:
Social Security Number
Residential Street Address, including apartment number
City
State
Zip Code
Mailing address, if different than above
City
State
Zip Code