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Your Name

Your Email Address

Subject/Target Name (Profile Name)

Subject/Target Location (Per Profile or Communication with You)

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Check all elements involved in your interactions

Check all elements involved in your interactions

What platforms or apps were involved?

What Platform did you most often communicate on?

How were you originally contacted?

If you lost money, how much money did you send/lose (estimate if not sure)?

Other Records (Attach any other records you think are relevant)

Provide a brief description of what happened or your situation:

When was your first interaction ?

When was your last interaction?

Provide other significant dates and a description of the related event:

Have you contacted law enforcement?

Which law enforcement agency or office?

Are you working with a lawyer?

Firm Name

Attorney Name

Attorney Email

Attorney Phone

Do you have an open case, investigation, or complaint with any business, entity or agency:

Do you have an open case, investigation, or complaint with any business, entity or agency:
A
B
C

Where do you have an open case?

What is the subject's phone number?

Would you like to schedule a consult?

Would you like to schedule a consult?
A
B
C

Your City

Your State

Your Zip Code

Your Country

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CONSENT & AUTHORIZATION I authorize Verafy to collect, store, analyze, and use the information I provide — including images, message histories, metadata, and uploaded files — for the purposes of identity verification, investigative analysis, and report generation related to the service tier I purchase. I affirm that I have a legitimate purpose and lawful basis for submitting this request and will not use Verafy for any unlawful, harassing, discriminatory, or invasive purpose. USE OF THIRD-PARTY SERVICES I understand Verafy uses third-party processors to perform parts of the service. These providers process data under their own terms and privacy policies. SENSITIVE USE & FCRA/BACKGROUND CHECK DISCLAIMER Verafy is not a consumer reporting agency and not a background check service. Verafy reports must not be used to make decisions about credit, employment, housing/tenant screening, insurance, or any FCRA-regulated purpose. Results are derived from public sources and automated analysis and may be incomplete or inaccurate. NOT LEGAL ADVICE Verafy is not a law firm and does not provide legal advice. Reports are informational and investigatory in nature. Admissibility or legal sufficiency is not guaranteed. DATA RETENTION & DELETION • Verafy: retains original uploads and derived report data to support your order and any follow-up (default retention: 30 days for Quick/Analyze tiers; 180 days for Report/Legal tier), unless a longer period is required by law or a legal hold. You may request deletion at support@verafy.co. Deletion requests do not affect data already shared with you or authorities at your request. SECURITY & AUDIT I consent to capture of submission metadata (timestamp, IP, device/browser information) for fraud prevention, audit trail, and consent logging. ACCEPTABLE USE I will not use Verafy to stalk, harass, threaten, dox, discriminate, or otherwise harm any person. I will respect applicable privacy, intellectual property, and other laws.
ACKNOWLEDGMENTS I have read and agree to Verafy’s Terms of Service (https://verafy.co/terms) and Privacy Policy (https://verafy.co/privacy). I understand the limits and intended uses described above.
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