Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Equifax Data Breach Intake Form
Check to see if you have been hacked and sign up
Sign in to Google
to save your progress.
Learn more
* Required
Email Address
*
Your answer
Name
*
Your answer
Address:
*
Your answer
Cell Phone
*
Your answer
Other Contact Method
Your answer
Have you checked to see if you were impacted by the Equifax Data Breach?
*
Yes
No
If so, was your information breached (hacked)?
*
Yes
No
Maybe
I don't know
If you are not sure, you should check here:
https://trustedidpremier.com/eligibility/eligibility.html
Even if it says you were not impacted, we recommend that you sign up.
It says I may have been impacted
It says I was impacted
It says I was not impacted
Clear selection
Have you ever signed up for Equifax Premier? If so, let us know. If not, DO NOT ENROLL or sign up for this program, you may waive your rights to participate in this litigation!
*
Yes
No
Maybe
How did you find us? (Let us know the name of the person who referred you, if applicable)
Your answer
By placing your name below, you will agree to have Yearout & Traylor represent you based on the attached contract:
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Yearout & Traylor.
Report Abuse
Forms
