Credit Bureau Dispute Form

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Credit Bureau Dispute Form
Account Number: _________________________
Borrower Name: _____________________________________________
SSN: _______________________________________________________
Address: ____________________________________________________
Date of Birth: ________________________________________________
Phone Number: _______________________________________________
Explanation of Dispute:
Additional information may be required such as:
• Copy of consumer report in dispute
• Police Report
• Fraud Report
• Account Statement
Dispute Completed by: _________________________________
Date: ___________________
To ensure this credit dispute is reviewed promptly the original signed form must be completed and mailed to the
below address.
Attention: Loan Operations First Federal Bank of Florida
City, Florida
4705 West US HWY 90 Lake


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Parent category: Financial