REFUSED CREDIT INFORMATION REQUEST

Date:
To:
Dear
I have recently been declined credit by your firm on the transaction described below. In
accordance with the Federal Fair Credit Reporting Act, I am requesting a full and complete
disclosure of the reasons for this denial of credit and the nature of any adverse credit information
received from any source including a consumer reporting agency, and the identity of such source
that submitted adverse credit information against me.
____________________________________ ___________________________________
Signed Full Name
____________________________________ ___________________________________
Date of Credit Application Address
____________________________________ ___________________________________
Transaction or Type of Credit Telephone Number
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