To Whom It May Concern:
Please send me a copy of my credit report.
Full name: ________________________________
Date of birth: ______________________________
Social Security number: ______________________
Spouse's name: _____________________________
Telephone number: _________________________
Current address: ____________________________
[ ] Because of information in my credit file, __________________ took the following action on __________________, 20___. (I enclose a copy of the notice I received):
[ ] Denied me credit.
[ ] Granted me credit, but not near the amount or on the terms that I requested.
[ ] Terminated my credit account.
[ ] Made unfavorable changes to my account (but did not change the terms of all, or substantially all of the consumer accounts of the same type).
[ ] Took the following adverse action or determination in connection with my application for __________________.
[ ] Took the following adverse action or determination in connection with [describe the transaction] __________________.
[ ] I hereby certify that I am unemployed and intend to apply for a job within the next 60 days.
[ ] I hereby certify that I receive public assistance/welfare.
[ ] I hereby certify that I believe there is erroneous information in my file due to fraud.
[ ] I do not know of any reason that allows me to get a free credit report. Enclosed is a copy of a document identifying me by my name and address and payment in the amount of $__________________.
Thank you for your attention to this matter.
Enclosures: ___[list, if any]___