Fill and Sign the Letter Denying Credit Form

Letter Denying Consumer Credit and Notice of Rights under Equal Credit Opportunity Act _________________________________________________ (Name of Creditor) _______________________________________________________________________ (Address of Creditor) __________________________________ (T elephone Number) ____________________________________ (Date) Dear Applicant: Thank you for applying to us for (describe type of credit) _________________________ _____________________________ . After carefully reviewing your application, we are sorry to advise you that we cannot (e.g., open an account for you or grant a loan to you or increase your credit limit) _____________________________________________________ at this time. If you would like a statement of specific reasons why your application was denied, please contact our credit service manager shown below within 60 days of the date of this letter. We will provide you with the statement of reasons within 30 days after receiving your request. If we obtained information from a consumer reporting agency as part of our consideration of your application, its name, address, and telephone number is shown below. You can find out about the information contained in your file (if one was used) by contacting: ____________________________________________ ( Name of Consumer Reporting Agency) ______________________________________________________________________________ (A ddress of Consumer Reporting Agency) __________________________________ ( Telephone number) You have the right under federal law, on request and the presentment of proper identification, to full disclosure of the nature and substance of all information (except medical) concerning you in the files of the consumer reporting agency. You also have the right to obtain a free copy of the consumer report on you from the consumer reporting agency and to dispute with the reporting agency the accuracy or completeness of any information in the consumer report furnished by the agency. Sincerely yours, __________________________________________ __________________________________________ Signature & Name of Office or Position 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, or 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 appropriate agency listed in 12 C.F.R. Part 202, Appendix A ) ________________ ______________________________________________________________________________ _____________________________________________________________________________ . Sincerely yours, __________________________________________ __________________________________________ Signature & Name of Office or Position Date: __________________________________