Credit Dispute Form

Creditor

Client

Name: _____________________________________

Name: _____________________________________

Address:___________________________________

Address: ___________________________________

__________________________________________

___________________________________________

Account #__________________________________

Daytime Phone: ______________________________

 

Evening Phone: ______________________________

 

Date of Birth: ________________________________

 

Social Security #______________________________

To Whom It May Concern:

 

Please note that the following changes should be made on the above referenced account.

    • This account does not belong to client
      This account was included in bankruptcy
      (Enclosed schedule of debtors and discharges)
    • Account is paid in full
      (Enclosed receipt)
    • Other______________________________________________________

 

Comments _________________________________________________________

 

Please notify me in writing when this matter is corrected

 

Sincerely, __________________________________________________________



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