Date:
Applicant’s Name:
Applicant’s Address:
Description of Account, Transaction, or Requested Credit:
Description of Action Taken:
Part I—PRINCIPAL REASON(S) FOR CREDIT DENIAL,
TERMINATION, OR OTHER ACTION TAKEN CONCERNING CREDIT
This section must be completed in all instances.
-
Credit application incomplete
-
Insufficient number of credit references
provided
-
Unacceptable type of credit references
provided
-
Unable to verify credit references
-
Temporary or irregular employment
-
Unable to verify employment
-
Length of employment
-
Income insufficient for amount of credit
requested
-
Excessive obligations in relation to income
-
Unable to verify income
-
Length of residence
-
Temporary residence
-
Unable to verify residence
-
No credit file
-
Limited credit experience
-
Poor credit performance with us
-
Delinquent past or present credit obligations
with others
-
Collection action or judgment
-
Garnishment or attachment
-
Foreclosure or repossession
-
Bankruptcy
-
Number of recent inquiries on credit bureau
report
-
Value or type of collateral not sufficient
-
Other, specify:
Part II—DISCLOSURE
OF USE OF INFORMATION OBTAINED FROM AN OUTSIDE SOURCE
This section should be completed if the credit decision
was based in whole or in part on information that has been obtained
from an outside source.
Our
credit decision was based in whole or in part on information obtained
in a report from the consumer reporting agency listed below. 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. Name:
Address:
[Toll-free]
Telephone number:
[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:
]]
Our credit decision
was based in whole or in part on information obtained from an affiliate
or from an outside source other than a consumer reporting agency.
Under the Fair Credit Reporting Act, you have the right to make a
written request, no later than 60 days after you receive this notice,
for disclosure of the nature of this information. If you have any questions regarding this notice, you
should contact:
Creditor’s name:
Creditor’s address:
Creditor’s telephone number:
NOTICE: The federal Equal Credit Opportunity Act prohibits
creditors from discriminating against credit applicants on the basis
of race, color, religion, national origin, sex, marital status, age
(provided the applicant has the capacity to enter into a binding contract);
because all or part of the applicant’s income derives from any
public assistance program; or because the applicant has in good faith
exercised any right under the Consumer Credit Protection Act. The
federal agency that administers compliance with this law concerning
this creditor is (name and address as specified by the appropriate
agency listed in appendix A).
