Identity Theft Form March 17, 2015 The first step when you think someone has stolen your identity is to fill out this ID Theft Form – it allows us to immediately begin working on your behalf. County of Membership * Membership Number First Name * Last Name * Street Address * Apt. or Suite Number City * State * ZIP Code * Phone Number * Secondary Phone Number (cell phone, work, etc.) Email Address Best time to contact * MorningAfternoonEvening Best method of contact * PhoneEmailBoth When was the problem discovered? * Are there past issues with identity theft? * Brief explanation of the ID theft issue * Please leave this field empty.