Dispute Intake Form

The Fair Credit Reporting Act (FCRA) allows you to dispute the accuracy of any information provided in the background check processed by JD Palatine LLC, dba JDP and its affiliates or any agency.

Please fill out as much information as possible so that we can start your dispute.

First Name*

Last Name*

Date of Birth (MM/DD)*

Last 4 digits of SSN*

Email Address

Phone Number*

Background Check Case #

Search Number

General Dispute Reason*

Summary of Dispute*

Captcha Verification*

Dispute Intake Form

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