IDENTITY THEFT VICTIMS SUPPORT GROUP OF NORTH AMERICA

Feedback & Questionaire

First Name
Last Name
Company Name
Address Line 1
Address Line 2
City
State
Zip Code
Daytime Phone	() -
Evening Phone	() -
Fax	() -
E-mail Address
Comments
Victims Comment Only
Approx. Amount Lost
Police Report Filed (Yex or No)
Report Filed With FTC (Yes or No)
Credit Bureau Files Frozen (Yes or No
Did ID Theft Create an Arrest Warrant On You (Yes or No
Was Your ID Theft Full Blown (Yes or No) SSN, D-License, .Bank Accts., Credit Files, Etc.
Number of Months Spent to Clear-Up Theft
Approx TIme It Took To Clear Up Mess (Weeks, Months, Years)
Approx. Out of Pocket Expense You Incurred Clearing Up the Theft
Has Accounts Cleared by Credit Bureaus, Reappear on Credit Files after 6 Months or More (Yes or No) and (How Many)
Was the Identity Theft Committed by a Family Member, Friend, Neighbor, Bank Employe, Restaurant Employee, or Stranger

You can send your ID Theft Victim Stories to : Identity Theft Victims U.S., Attention: Victim Stories, P.O. Box 940867, Plano, TX. 75094-0867

† ID Theft Victims Support Group of North America †

“Identity Theft Is No Longer Someone Else’s Problem; It Is Everyone’s Problem”

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