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Dispute
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DisputePortlet
Component Action Menu
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Actions
Terms and Conditions
I AGREE
I DO NOT AGREE
Have you received your Consumer Disclosure Report?
Have you received your Consumer Disclosure Report?
Yes
No
Age Verification
Age Verification
Yes
No
* = required
ChexSystems Consumer ID
ChexSystems Consumer ID Number
Personal Details
*
Name:
Suffix:
Sr.
Jr.
I
II
III
IV
V
*
Date of Birth:
/
/
*
U.S. SSN:
-
-
*
Verify SSN:
-
-
DL Number:
State of Issuance:
 
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
MY
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Address Details
*
Current Address Line 1:
Current Address Line 2:
*
City:
*
State:
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
Postal Code:
Telephone #:
-
-
If you are disputing multiple items, you will need to enter each dispute separately. You may submit up to 50 disputes per session.
Select the
Dispute Another Item
button if you are disputing multiple items. You may submit up to 50 disputes per session.
Dispute Another Item
Remove Last Dispute
You may upload up to 5 documents with a combined size totaling no more than 25MB. The acceptable document formats are:
JPG
BMP
PNG
TIF
TXT
RTF
PDF
DOC
DOCX
Select file(s) to upload:
Security Information
*
Enter the security code shown at right:
Get new code
If you have no additional items to dispute, select
Submit
.
Submit
Cancel
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