CITY PROVINCE POSTAL CODE PREVIOUS ADDRESS(ES) WITHIN LAST 3 YEARS PLEASE PRINT: PREVIOUS STREET ADDRESS PLEASE PRINT: E-MAIL Address DATE OF BIRTH: MONTH/DAY/YEAR S.I.N.: (OPTIONAL) SIGNATURE NAME LAST 4 DIGITS OF MAJOR CREDIT CARD: (OPTIONAL) DATE YES, I WOULD ALSO LIKE TO PURCHASE MY EQUIFAX CREDIT SCORE FOR 11.95 (tax included) and I authorize Equifax to charge the payment to my credit card: VISA MasterCard AMEX Cardholder Name: Card Number: Expiry Date: MONTH/YEAR Note: Cheque and cash payments are not accepted..
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