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6-077

Form C-4—Sample Notice of Action Taken, Statement of Reasons, and Counteroffer

Date
Dear Applicant:
Thank you for your application for 

. We are unable to offer you credit on the terms that you requested for the following reason(s): 

We can, however, offer you credit on the following terms: 

If this offer is acceptable to you, please notify us within [amount of time] at the following address: 
.
Our credit decision on your application was based in whole or in part on information obtained in a report from [name, address and [toll-free] telephone number of the consumer reporting agency]. You have a right under the Fair Credit Reporting Act to know the information contained in your credit file at the consumer reporting agency. The reporting agency played no part in our decision and is unable to supply specific reasons why we have denied credit to you. You also have a right to a free copy of your report from the reporting agency, if you request it no later than 60 days after you receive this notice. In addition, if you find that any information contained in the report you receive is inaccurate or incomplete, you have the right to dispute the matter with the reporting agency.
[We also obtained your credit score from this consumer reporting agency and used it in making our credit decision. Your credit score is a number that reflects the information in your consumer report. Your credit score can change, depending on how the information in your consumer report changes.
Your credit score: 
Date: 
Scores range from a low of 
to a high of 
Key factors that adversely affected your credit score:




[Number of recent inquiries on consumer report, as a key factor]
[If you have any questions regarding your credit score, you should contact [entity that provided the credit score] at:
Address: 

[Toll-free] Telephone number: 
]]
You should know that the federal Equal Credit Opportunity Act prohibits creditors, such as ourselves, from discriminating against credit applicants on the basis of their race, color, religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter into a binding contract), because they receive income from a public assistance program, or because they may have exercised their rights under the Consumer Credit Protection Act. If you believe there has been discrimination in handling your application you should contact the [name and address of the appropriate federal enforcement agency listed in appendix A].
Sincerely,

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