Credit Dispute Form

ATTENTION: ___________________________________________________________

(Name of Credit Reporting Firm)

I Dispute the completeness and/or accuracy of my credit file as revealed to me on ___________________(Date)

In accordance with Section 611 of the Fair Credit Reporting Act, I hereby request that you re-investigate and record the correct current status of the information I have disputed below in paragraph 1. Under section 15 U.S.C. § 1681s of the FCRA, a wronged party may collect $1000 for each willful or negligent act which results in the violation of the FCRA and I intend to act upon this to the fullest extent.

1. The disputed portion reads:________________________________________________

_________________________________________________________________________

2. I maintain that: __________________________________________________________

_________________________________________________________________________

(This section may be limited to 100 words if the reporting firm assists in writing the summary)

_______________________________ ____________________

(Name in Print) (Date)

_________________________________________________

(Signature)

_________________________________________________

(Street Number and Name)

_________________________________________________

(City, State, Zip)

(________________)-(___________)-(________________)

(Social Security Number)

NOTE: I HAVE INCLUDED A COPY OF MY DRIVER'S LICENSE AND MY SOCIAL SECURITY CARD ALONG WITH A VOIDED CHECK TO PROVE MY ADDRESS AND THE AUTHENTICITY OF THIS DISPUTE. PLEASE CORRECT THESE ISSUES IN ACCORDANCE WITH THE FAIR CREDIT REPORTING ACT. IN ADDITION, PLEASE SEND ME MY WRITTEN COPY OF MY CREDIT REPORT EXPLAINING YOUR ACTIONS AND THE CURRENT SATUS OF EACH OF MY DISPUTES PER YOUR INVESTIGATION RESULTS.