[[Date]]

Chex Systems, Inc.

Attn: Consumer Relations
7805 Hudson Road, Suite 100
Woodbury, MN 55125
To Whom It May Concern:

I was informed recently when I tried to open a checking account that I have negative information in my
ChexSystems record.

I am unaware of any negative entries and to my knowledge have never had non-sufficient funds. Please
kindly forward me a copy of my ChexSystems record so that I may verify its accuracy. My Address is
below.

Sincerely,

[[Your Name]]
[[Your Address]]
[[Your SS#]]
[[Your DOB]]