Credit Bureau Report Dispute Form printable pdf download

Credit Bureau Report Dispute Form

Customer Name: ___________________________ Date of Dispute: ______/______/______

Customer SS#

___________________________ Date of Birth:

______/______/______

Customer Phone: (______)______-_____________

Customer Address:____________________________________________________________

____________________________________________________________

Account Number(s) under Dispute: _______________________ , ______________________ ,

___________________________ , _______________________ , ______________________

Disputed Information and Basis for Dispute: _______________________________________

____________________________________________________________________________

Please attach any additional information that will assist The Bank of Missouri in investigating

this dispute.

==============================================================================

Internal Use Only-Forward this form to The Bank of Missouri Compliance Department as soon

as possible. We have limited time to complete an investigation and to respond to the disputed

information.

Investigation Completed by: ______________________________ Date: ___________________

Results of Investigation: __________________________________________________________

______________________________________________________________________________

AUD Filed ( Y / N )

JH Updated ( Y / N )

Credit Bureau Report Dispute Form