ADVERSE CREDIT ACTION
REQUEST FOR DENIAL REASON
Date:
To:
From:
On ______________________, I was notified that my credit application dated _________________, was denied based upon information you received from a source other than a consumer credit reporting agency. Pursuant to my rights under the Fair Credit Reporting Act, Title 15, USC, �1681m (b), I request that the nature of the information you received be disclosed to me. Please send such information to me at the above address.
________________________________
Signature
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