Note to Consumer
  • You have the right to obtain a free copy of your consumer information file report every 12 months (also known as an "annual file disclosure"), from nationwide specialty consumer reporting agencies such as CrossCheck, Inc. Your CrossCheck file report may contain information on negative checkwriting history, which may be used by CrossCheck to make decisions on whether to approve or decline a check. Your file report is not provided or disclosed to any third party as part of this process.
  • For more information on obtaining your free file report, visit, call 1-800-843-0760 or write to CrossCheck, Inc., Attn: Consumer Inquiry Department, P.O. Box 6008, Petaluma, CA 94955-6008.
  • By submitting this request, you hereby affirm that you are the person on whose behalf this consumer file report inquiry is being made and that all the information herein submitted is true and correct to the best of your knowledge.
  • You should receive your file report within 15 days.
You are submitting this form for:
An Annual Report, or
An Annual Report with Check Decline Details.
ANNUAL REPORT The following information is required to process your request for your annual file disclosure:
(Required fields are indicated by *)

You are submitting this request as an individual or, as a business.


CHECK DECLINE If you are requesting a file disclosure in reference to a declined check, your request must include the following additional information:
Number of Declined Checks:

Check 1

Check 2

Check 3

Check 4

Check 5

Check 6