Victim Information Form

Pima County Attorney's Office Bad Check Program

INSTRUCTIONS:

Please read the GUIDEBOOK before completing this form. Incomplete or submissions may be returned. Complete this form the first time you submit a check to the Bad Check Program unless you change your address.

(Not a Business) Complete the following:

Address(Required)

Complete the Following

Note: If you have more than one location where checks are accepted, submit one VIF per store.

Business Address:(Required)
Physical Address: (if different)

When we have questions about your checks or need to contact your company:

Restitution Checks Should be Made:

Mailing Address:(Required)

ONCE A CHECK IS SUBMITTED TO THE PROGRAM:

Avoid contact with the Check Writer. Do not accept any payments from the Check Writer. Have the Check Writer contact the PCAO office for payment arrangements

PROTECT YOURSELF:

Develop and post for employees and customers a check cashing policy that includes inspecting and recording Photo ID (Driver License or ID #) on every check.

Please sign acknowledging that you have read the information above:

MM slash DD slash YYYY

Submit to PCAO Bad Check Program, 32 N. Stone Ave, 2nd Fl, Tucson, AZ 85701. Questions: (520) 724-4100