Fill and Sign the Statementofcreditdenialterminationorchange Lampampc3 Form

STATEMENT OF CREDIT DENIAL, TERMINATION, or CHANGE L&C3Date: ___________________________Applicant:_____________________________________________ ________________________________________________________________________________________________ Description of Account, Transaction, or Requested Credit:The Principal Reason(s) For Credit Denial:[ ] Credit application incomplete[ ] Insufficient number of credit references[ ] 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[ ] Value or type of collateral not sufficient[ ] Too short a period 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[ ] Garnishment, attachment, foreclosure, repossession, collection action, or judgment suit[ ] Bankruptcy[ ] Other (specify):______________________________________________________________________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._______________________________________________________________________________________________________________________________________________________________Phone:_______________________________________________[ ] Our credit decision was based in whole or in part on information obtained 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:_______________________________________________________________________________________________________________________________________________________________Phone:_______________________________________________NOTICEThe 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 (providing the applicant has the capacity to enter into a binding contract); because all or a 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: _______________________________________________________________________________________________________________________________________________________________Phone:_______________________________________________