For EZ
Shield
Customers Only
Our Customers
Security Tips
About EZ
Shield
Have you been a victim of check fraud or identity theft? Choose the appropriate option below to report your incident or
contact us
to receive the necessary forms via complimentary overnight delivery.
by Phone
by Email
or email us at
info@ezshield.net
by filling out this Form
Full Name
Address
City
State
---
AL
AK
AZ
AR
AA
AE
AP
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Zip
Phone
Email
Describe nature of fraud
Date loss Incurred
Month
01
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11
12
Day
01
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31
Year
2007
2008
Date loss discovered
Month
01
02
03
04
05
06
07
08
09
10
11
12
Day
01
02
03
04
05
06
07
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13
14
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18
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21
22
23
24
25
26
27
28
29
30
31
Year
2007
2008
Have you...?
Contacted your bank
Filed a police report
Please enter police report #
Location of loss
Has the loss involved a...?
Family member
Resident of your household
Describe damages claimed