| (Not all creditors report to the same agency. Send a
request to each credit reporting agency.) |
| Type or print clearly. Provide all requested information. |
| _______ Please send a copy of my PERSONAL credit
report |
| _______ Please send a copy of our JOINT credit
report |
| _______ A check or money order is enclosed (if
required) |
| _______ I/We were DENIED CREDIT, EMPLOYMENT or
INSURANCE within the past 30-60 days by: (Name of Firm Here),
because the information contained in my/our credit files at your agency.
A copy of the letter of denial is enclosed. I/We understand a copy of
my/our credit report will be sent without charge. |
| |
| Date: ____/____/____ |
Daytime Phone: :( ______ ) __________-______________ |
| Your Full Name: |
__________________________________________________
(Last), (First) (M.I.), (Jr.,Sr.,2nd, etc.) |
| Spouse's Full Name: |
_____________________________________________
(Last), (First) (M.I.), (Jr.,Sr.,2nd, etc.) |
| Current Address: |
_____________________________________________ |
| Mailing Address: |
_____________________________________________
(P.O. Box, etc. if different from above) |
| |
City _____________________ State ______ Zip
__________ |
| Previous Address(es): |
__________________________________________________
(Past Five Years) |
| Marital Status: |
_________________ |
| Your Date of Birth (DOB): |
____/____/____ |
| Spouse's DOB: |
____/____/____ |
| Your SSN: |
_________-________-_________ |
| Spouse's SSN: |
_________-________-_________ |
| Your Current Employer: |
___________________________________________ |
| Spouse's Current Employer: |
___________________________________________ |
| Your Signature: |
___________________________________________ |
| Spouse's Signature: |
___________________________________________ |
