Credit Report Direct Dispute Form

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C R E D I T U N I O N
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CREDIT REPORT DIRECT DISPUTE FORM
To be completed by member or co-borrower who is disputing information furnished to a credit reporting agency
by Eagle LA FCU. Disputes in other formats may be accepted in lieu of this form as long as the letter or form
contains adequate information to determine the correct account or loan and the information being disputed with
documentation supporting dispute attached.
Name: _______________________________ Account #: ______________ Loan #: ______________
Loan Type: _______________________________________ SSN: ___________________________
Address: __________________________________________________________________________
Daytime Telephone Number: __________________________________________________________
Specific Information Being Disputed: Attach copy of relevant portion of credit report that contains the disputed
information and describe why it is inaccurate here:
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
List and attach all documentation you have that support your belief that the information is inaccurate (for
example, copies of canceled checks, copies of loan documents, police reports or fraud/identity theft affidavit, a
court order or account statements).
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Eagle FCU will review your dispute and furnish you with the results of our investigation within 30 days from the
date we receive this form. If the investigation finds that the information reported is inaccurate, we will promptly
notify each credit reporting agency which obtained inaccurate information and provide a correction to them.
Eagle FCU is not required to investigate frivolous or irrelevant disputes if we have reasonably determined that
you did not provide sufficient information to investigate the disputed information or the dispute is substantially the
same as a dispute previously submitted and which we have already investigated.
I certify that the above statements are true and correct and that I have not previously disputed the same
information which was determined to be correct or if I have previously disputed the same information; this report
contains information that was not previously provided to the credit union in the previous review.
_________________________________________
___________________________
Signature
Date
To be completed by Eagle FCU.
Received by (employee initials/teller number): ______________ Date: ______________
Results of Investigation: ______________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Reported to CRAs on: _________________________ Letter to member dated: __________________________
Investigation completed by: _________________________________________ (signature)
P.O. Box 64630 Baton Rouge, LA 70896
Ph: 225-927-1900 or 888-281-8485
Fax: 225-927-1960

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