Chex Systems, Inc.

ATTN: Consumer Relations

7805 Hudson Road, Suite 100
Woodbury, MN 55125
www.chexsystems.com
Toll Free: Fax:
800-513-7125 602-659-2197

Current Date
JOHN CONSUMER
ADDRESS
CITY STATE ZIP

Consumer ID 12345678 for JOHN C CONSUMER

This report was prepared using the identifiers provided by you. Please provide your Consumer ID number along
with your name and Social Security number in any future contact with Chex Systems, Inc.

Personal Information
This section displays personal information you have provided to ChexSystems. This could include information
such as names, date of birth, addresses, phone numbers and email addresses.

Names: JOHN CARTER CONSUMER; JOHN CONSUMER;

Addresses:
123 MAIN ST, ANYTOWN, MN 55125-0000

Phone Numbers: (602) 555-1234

Email Addresses:
johnconsumer1@email.com

Date of Birth:
mm/dd/yyyy

Security Freeze Record

In any future contact regarding your Security Freeze, you will be required to provide your personal identification
number (PIN).

Name on Freeze: JOHN CARTER CONSUMER XXX-XX-1234 Status: CURRENTLY ON FILE

Consumer Reported Identity Theft Security Alert

In any future contact regarding your Security Alert, you will be required to provide the answer to your password
question.

Name on Alert: JOHN CONSUMER SSN: XXX-XX-1234

Password Question: IN WHAT CITY WERE YOU BORN? Status: VALIDATED
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 Reported Information
ChexSystems' clients, which consist mainly of financial institutions, furnish information on closed checking and
savings accounts, referred to as reported information. ChexSystems’ current practice is to retain reported
information for a period of five years. The source is under no obligation to remove accurate information, even if
paid, but is obligated to update the report with a paid in full or settled in full status and date when applicable.

Source of Information: ANYTOWN BANK; 678 BANK BLVD, ANYTOWN MN 55125

Phone Number: Telephone Number Not Available

Reported For: SUSPECTED FRAUD ACTIVITY Date of Closure: mm/dd/yyyy

Reported Name: JOHN CARTER CONSUMER RTN/ACCT#: 012345678 / XXXXXXXXXXXX9876
Reported Address:123 MAIN ST Original Charge Off Amount: $175.79
ANYTOWN, MN 55125-0000 Closure Status: UNPAID
Reported SSN/ID: XXX-XX-1234 Closure Status Date: mm/dd/yyyy
Driver’s License: State:

Source of Information: MY TOWN CREDIT UNION; 987 COMMMERCE WAY, MY TOWN, MN 55126
Phone Number: 800.555.1234

Reported For: NON-SUFFICIENT FUNDS(NSF) ACTIVITY; Date of Closure: mm/dd/yyyy

Reported Name: JOHN CONSUMER RTN/ACCT#: 987654321 / XXXXX8380
Reported Address: 123 CITY ST Original Charge Off Amount: $662.27
MY TOWN, MN 55126-7570 Closure Status: PAID IN FULL
Reported SSN/ID: XXX-XX-1234 Closure Status Date: mm/dd/yyyy
Driver’s License: XXXX9012 State: MN

Inquiries Viewed By Others

This section refers to transactions involving you and are the result of someone accessing your ChexSystems
information, typically in connection with a business transaction you initiated with them. The company listed on
this type of inquiry requested information from your consumer file on the date(s) specified. These inquires may
impact your consumer report and may be included in reports to others. These inquiries remain on your file for
up to 3 years.

Inquirer: SECOND NATIONAL BANK; 111 SOUTH ST, ANYTOWN, MN, 55125
Phone Number: Telephone Number Not Available
Inquiry Date: mm/dd/yyyy SSN/ID Provided: XXX-XX-1234
Name: JOHN C CONSUMER Driver’s License: XXXXXXXXXX0370
Address: 123 MAIN ST State: MN
ANYTOWN, MN 55125 Phone Numbers: 602.555.1234, 602.555.4321
Email: johnnyc1984@email.com

Inquirer: ABC COMPANY LLC; 223 EAST ST, ANYTOWN, MN, 55125
Phone Number: 800.555.8000
On Behalf Of: XYZ SOLUTIONS; 5555 DOLPHIN BLVD, CITYTOWN, FL 12345
Phone Number: 888.555.2345
Inquiry Date: mm/dd/yyyy SSN/ID Provided: XXX-XX-1234
Name: JOHN CONSUMER Phone Number: 602.555.1234
Address: 123 CITY ST Email: johnconsumer1@email.com
MY TOWN, MN 55126
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 Check Cashing Inquiries
Check cashing inquiries refers to inquiries received by Certegy Check Services, as a result of a check cashing
transaction initiated by you. ChexSystems receives record of the inquiries directly from Certegy Check Services
and retains a record of the inquiry for a period of two years. Please note that these inquiries are a part of your
ChexSystems history and may be included in our reports to others.
For additional information you may contact Certegy Check Services, by telephone at 800.437.5120 or in writing
to Certegy Check Services, P.O. Box 30046, Tampa, FL 33630-3046.

Inquirer: LOCAL STORE Inquiry Date: mm/dd/yyyy Inquiry Dollar Amount: $87.00
SSN/ID Provided: XXX-XX-1234 Driver’s License: State:

Inquiries Viewed Only By You

This section refers to transactions you may or may not have initiated. For this reason, you may not always
recognize the source. Inquiries made by medical providers may also be included in this section. The
information listed in this section is only viewable by you. It is not included in reports to others and does not
negatively affect your consumer report.

No Information Found

Retail Information
Retail Information refers to returned checks reported by retailers and other businesses to Certegy Check
Services. ChexSystems receives this information from Certegy Check Services, is not involved in the collection
of these items, and retains record of retail information for a period of four years.
For additional information you may contact Certegy Check Services, by telephone at 800.437.5120 or in
writing to Certegy Check Services, P.O. Box 30046, Tampa, FL 33630-3046.

Payee: LOCAL MERCHANT Amount Of Check: $100.00 Date of Check:

Check Number: 107 Date Check Paid: NOT PAID YET mm/dd/yyyy
Driver’s License: XXXX9012 State: MN RTN/ACCT#: 123456789 / XXXXXXXXXXXXXXXX1932

Payee: MERCHANT STORE Amount Of Check: $251.00 Date of Check:

Check Number: 2012 Date Check Paid: mm/dd/yyyy mm/dd/yyyy
Driver’s License: XXXX9012 State: MN RTN/ACCT#: 05150291 / XXXXXXXXXXXXXXXX1788

History of Checks Ordered

This section displays the check order information that has been reported to ChexSystems within the past five
years. Not all check orders are reported to ChexSystems, therefore, this section may not display all orders that
have been placed.

Source of Information: HARLAND CHECK PRINTING; 400 BROADWAY AVENUE, SAN DIEGO, CA 92101
Phone Number: Telephone Number Not Available
Name: JOHN C CONSUMER SSN/ID: Driver’s License: State:
RTN/ACCT#: 123456789 / Quantity Ordered: 100 Date Order Shipped:
XXXXXXXXXXXXXXXX1001 mm/dd/yyyy
Check Start Number: 1125

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 Social Security Number Validation
Social Security Number Validation indicates the year and state that a particular sequence of digits first became
available for issuance by the Social Security Administration, or that a particular sequence of digits is available for
randomized issuance. This information does not include the name of the individual to whom the number was
issued.

XXX-XX-1234 BECAME AVAILABLE FOR ISSUANCE IN 1989 IN MN

Notices
You have a right to dispute any item of information contained in your consumer file. If you believe information in
your file may be inaccurate or incomplete, you may submit a dispute to ChexSystems using any contact method
listed in the letterhead.

Please be certain to include your Consumer ID number, the source of the information you are disputing and the
nature of your dispute. ChexSystems will mail a letter to notify you of the results of the reinvestigation within
approximately 30 days (21 days for residents of Maine) from the date we receive the dispute. if additional
information or documentation relevant to the dispute is provided by you during the course of the reinvestigation,
the time frame may be extended by up to 15 days to allow the source sufficient time for review.

You may have a right to place a security freeze on your consumer file. To obtain more information or to place an
alert or freeze on your consumer file at ChexSystems, please visit our website at www.chexsystems.com. If you are
a current resident of AK, AR, CA, CO, DE, DC, FL, GA, IN, MD, MA, MO, MT, NH, NJ, NM, NY, NC, ND, OH, OK, RI, TN,
VT, VA, WV, or WI there may be additional rights and information available to you. Please visit our website at
www.chexsystems.com and select the “Security Freeze” link or contact us at the address or telephone number
listed above to request a written copy of any applicable state notices.

By submitting your personal information to ChexSystems, you acknowledge your agreement to provide accurate
identifying information and your understanding that ChexSystems may access, store, and use this information to
the extent permitted by law.

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 A Summary of Your Rights under the Federal Fair Credit Reporting Act
Para informacion en espanol, visite www. consumerfinance.gov/learnmore o escribe a la Consumer Financial
Protection Bureau, 1700 G St. NW, Washington DC 20552.
The federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files
of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and
specialty agencies (such as agencies that sell information about check writing histories, medical records, and
rental history records). Here is a summary of your major rights under the FCRA. For more information, including
information about additional rights, go to www.consumerfinance.gov/learnmore or write to: Consumer Financial
Protection Bureau, 1700 G St. NW, Washington DC 20552.
• You must be told if information in your file has been used against you. Anyone who uses a credit report or
another type of consumer report to deny your application for credit, insurance, or employment – or to take
another adverse action against you – must tell you, and must give you the name, address, and phone number of
the agency that provided the information.
• You have the right to obtain a copy of your consumer disclosure report. You may request and obtain all the
information about you in the files of a consumer reporting agency (your “file disclosure”). You will be required
to provide proper identification, which may include your Social Security number. In many cases, the disclosure
will be free. You are entitled to a free file disclosure if:
 a person has taken adverse action against you because of information in your credit report;
 you are the victim of identity theft and place a fraud alert in your file;
 your file contains inaccurate information as a result of fraud;
 you are on public assistance; or
 you are unemployed but expect to apply for employment within 60 days.
In addition, all consumers are entitled to one free disclosure every 12 months upon request from each
nationwide credit bureau and from nationwide specialty consumer reporting agencies. See
www.consumerfinance.gov/learnmore for additional information. You can request a copy of your Chex Systems,
Inc. (ChexSystems) consumer disclosure report by visiting our website at www.chexsystems.com, by voice
messaging at 800.428.9623, by mail at Chex Systems, Inc., ATTN Consumer Relations, 7805 Hudson Road, Suite
100, Woodbury, MN, 55125, or by fax at 602.659.2197.
• You have the right to ask for a credit score. Credit scores are numerical summaries of your credit-worthiness
based on information from credit bureaus. You may request a credit score from consumer reporting agencies
that create scores or distribute scores used in residential real property loans, but you may have to pay for it. In
some mortgage transactions, you will receive credit score information for free from the mortgage lender. To
request your ChexSystems consumer score, you may print the Consumer Score Order Form from our website at
www.chexsystems.com or call us at 800.513.7125 to request that we send the form to you. Complete and mail
the Consumer Score Order Form to Chex Systems, Inc., ATTN Consumer Relations, 7805 Hudson Road, Suite 100,
Woodbury, MN, 55125.
• You have the right to dispute incomplete or inaccurate information. If you identify information in your file that is
incomplete or inaccurate, and report it to the consumer reporting agency, the agency must investigate unless your
dispute is frivolous. See www.consumerfinanace.gov/learnmore for an explanation of dispute procedures.
• Consumer reporting agencies must correct or delete inaccurate, incomplete, or unverifiable information.
Inaccurate, incomplete or unverifiable information must be removed or corrected, usually within 30 days.
However, a consumer reporting agency may continue to report information it has verified as accurate.
• Consumer reporting agencies may not report outdated negative information. In most cases, a consumer
reporting agency may not report negative information that is more than seven years old, or bankruptcies that
are more than 10 years old.
• Consumer reporting agencies are not required to remove accurate derogatory information from the file of a
consumer, unless the information is outdated or cannot be verified.

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• Access to your file is limited. A consumer reporting agency may provide information about you only to people
with a valid need – usually to consider an application with a creditor, insurer, employer, landlord, or other
business. The FCRA specifies those with a valid need for access.
• You must give your consent for reports to be provided to employers. A consumer reporting agency may not
give out information about you to your employer, or a potential employer, without your written consent given
to the employer. Written consent generally is not required in the trucking industry. For more information, go to
www.consumerfinance.gov/learnmore.
• You may limit “prescreened” offers of credit and insurance you get based on information in your credit
report. Unsolicited “prescreened” offers for credit and insurance must include a toll-free phone number you
can call if you choose to remove your name and address from the lists these offers are based on. You may opt
out with the nationwide credit bureaus at 888.5 OPTOUT (888.567.8688). You may opt out with Chex Systems,
Inc. at 877.678.6885 or by visiting our website at www.chexsystems.com.
• You may seek damages from violators. If a consumer reporting agency or, in some cases, a user of consumer
reports or a furnisher of information to a consumer reporting agency violates the FCRA, you may be able to sue
in state or federal court.
• You may submit a complaint regarding ChexSystems by mail to Chex Systems, Inc., ATTN Consumer Relations,
7805 Hudson Road, Suite 100, Woodbury, MN, 55125 or by contacting the Consumer Financial Protection
Bureau at www.consumerfinance.gov/complaints.
• Identity theft victims and active duty military personnel have additional rights. For more information, visit
www.consumerfinance.gov/learnmore.
States may enforce the FCRA, and many states have their own consumer reporting laws. In some cases, you may
have more rights under state law. For more information, contact your state or local consumer protection agency
or your state Attorney General. For information about your federal rights, contact:

TYPE OF BUSINESS CONTACT

1. a. Banks, savings associations, and credit unions with total assets a. Consumer Financial Protection Bureau
of over $10 billion and their affiliates. 1700 G St. NW
Washington, DC 20552
855.411.2372
b. Such affiliates that are not banks, Savings associations, or b. Federal Trade Commission: Consumer Response Center– FCRA
credit unions also should list, in addition to the CFPB. 600 Pennsylvania Ave. NW
Washington, DC 20580
877.382.4357
2. To the extent not included in item 1 above:
a. National banks, federal savings associations, and federal a. Office of the Comptroller of the Currency
agencies of foreign Customer Assistance Group
1301 McKinney St., Suite 3450
Houston, TX 77010-9050
800.613.6743
b. State member banks, branches and agencies of foreign banks b. Federal Reserve Consumer Help Center
(other than federal branches, federal agencies, and insured P.O. Box 1200
state branches of foreign banks), commercial lending Minneapolis, MN 55480
companies owned or controlled by foreign banks, and 888.851.1920
organization operating under section 25 or 25A of the Federal
Reserve Act
c. Nonmember Insured Banks, Insured State Branches of Foreign c. FDIC Consumer Response Center
Banks, and insured state savings associations 100 Walnut St., Box 11
Kansas City, MO 64106
877.275.3342
d. Federal Credit Unions d. National Credit Union Administration
Office of Consumer Protection (OCP)
Division of Consumer Compliance and Outreach (DCCO)
1775 Duke St.
Alexandria, VA 22314
703.518.6300

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 TYPE OF BUSINESS CONTACT
3. Air Carriers Asst. General Counsel for Aviation Enforcement & Proceedings
Aviation Consumer Protection Division
Department of Transportation
1200 New Jersey Ave. SE
Washington, DC 20590
202.366.2220
4. Creditors Subject to Surface Transportation Board Office of Proceedings, Surface Transportation Board
Department of Transportation
395 E St. SW
Washington, DC 20423
202.245.0245 or 800.877.8339
5. Creditors Subject to Packers and Stockyards Act, 1921 Packers & Stockyards Headquarters
Stop 3601
1400 Independence Ave. SW
Washington, DC 20250
202.720.0219
6. Small Business Investment Companies Association Deputy Administrator for Capital Access
United States Small Business Administration
409 Third St. SW, 8th Floor
Washington, DC 20416
800.877.8339
7. Brokers and Dealers Securities and Exchange Commission
100 F St. NE
Washington, DC 20549
800.732.0330
8. Federal Land Banks, Federal Lank Bank Associations, Federal Farm Credit Administration
Intermediate Credit Banks, and Production Credit Associations 1501 Farm Credit Drive
McLean, VA 22102-5090
703.883.4056
9. Retailers, Finance Companies, and All Other Creditors Not Listed FTC Regional Office for region in which the creditor operates or Federal
Above Trade Commission: Consumer Response Center – FCRA
600 Pennsylvania Ave. NW
Washington, DC 20580
877.382.4357

ChexSystems Notice to Consumers

In addition to the information listed in this document, the following may also apply to you. If you need further
assistance in understanding your ChexSystems consumer disclosure report, you may call our toll-free number,
800.513.7125, at which personnel are accessible to you during normal business hours. In most circumstances,
ChexSystems does not currently require a consumer to pay a fee to obtain a consumer disclosure report.
• California: Under California Civil Code, Consumer Credit Reporting Agencies Act, Section 1785.19, you have the
right to bring civil action against anyone who improperly obtains access to a file or knowingly or willfully
misuses file data.
• Colorado: You may call our toll-free number and speak directly to a ChexSystems representative to notify us of
disputed information contained in your file. After following all dispute procedures, you may have the right to
dispute resolution under the Colorado Consumer Credit Reporting Act, Section 12-14.3-107, Consumers right to
file action in court or arbitrate disputes.
• Connecticut: Under Connecticut law, if after an investigation you are not satisfied with your consumer report,
you may contact the Connecticut Department of Banking. You have the right to bring civil action against anyone
who knowingly or willfully misuses file data or improperly obtains access to your file.
• Maine: Under Maine law, a consumer reporting agency must verify or remove disputed information within 21
days from the date the dispute was received.
• Maryland: You have the right submit complaints to the Commissioner of Banking and Consumer Credit at 500
Calvert St., Suite 402, Baltimore, MD, 21202 or call 888.784.0136. This document explains your rights with
regard to the services provided by ChexSystems under Maryland Commercial Law, Subtitle 12, Consumer
Reporting Agencies.

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• Massachusetts: Under Massachusetts law, we must provide someone to help you interpret the information in
your file. We must modify or remove inaccurate information after investigation of your dispute. We may not
charge a fee for this service. Any pertinent information and copies of all documents you have concerning a
dispute should be provided to us. You may be entitled to collect compensation, in certain circumstances, if you
are damaged by a person’s negligent or intentional failure to comply with the provisions of the credit reporting
act.
• Texas: After you have followed the dispute procedures and have received the results of an investigation, you
may be entitled to dispute resolution under Title 2, Business & Commerce Code, Chapter 20, Regulation of
Consumer Credit Reporting Agencies, Section 20.08, Consumer’s Right To File Action In Court Or Arbitrate
Disputes.
• Washington: In accordance with Washington statute (Title 19 RCW, Chapter 182), the information on the
previous pages explains your rights with regard to the services provided by ChexSystems. The agency responsible
for the enforcement of this statute is: Attorney General of Washington, 800 5th Avenue, Suite 2000,
Seattle, WA 98104-3188. Statewide toll-free number: 800.551.4636.