Universal Data Form
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1UNIVERSAL DATA FORM
This form has been approved for reporting or updating account information.
New
Change
If Change makes trade current, is previous delinquent history
Delete
to be deleted?
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(Do not include security passwords with codes below.)
Relative Measures Corp.
Subscriber Name:
CGA Subscriber Code:
EQUIFAX Subscriber Code:
Subscriber Address:
TRW Subscriber Code:
TU Subscriber Code:
CONSUMER INFORMATION
Surname
First
M.I.
Suffix SSN
DOB/Age
DeRosario
Delores
11/01/80
Current Address
City
State Zip
738 Shelley Street
Marietta, United States
Georgia 30544
Previous Address
City
State Zip
Telephone, if available
Current Employer Name
Occupation
City
State
Spouse Surname
First
M.I.
Suffix SSN
DOB/Age
Johnson
Terry
Additional Spouse Information (Complete only if joint account)
Spouse Address (if different)
City
State Zip
Spouse Employer Name
Occupation
City
State
CURRENT/HISTORICAL ACCOUNT INFORMATION (See tables on reverse side for codes.)
Payment History
Account Number
Present Status
Type
Indicate whether:
Date
High
Acct/
Balance Amount
MOP History, or
Open
Credit
Date
44-12456
MOP
Past Due
x
No. of Payments Delinquent
10/06/06 06/09/07 4500.00 4500.00 5433.80
6 m o n t h s
I9
Status/
Date
Maximum Delinquency
Credit
Metro Status Code
Terms/Amount
Last
Closed
ECOA
Limit
Payment
Date
Amount
MOP
Date*
97
5433.80
2
Historical Status
Type of Loan/Collateral
Special Comments/Remarks
No. of
Months 30 days 60 days 90 days
Membership/Contractual Liability
x
*Must be present when reporting a chargeoff or repossession.
Automated
Manual
When you sign this form, you certify that your computer and/or manual records have been adjusted to reflect any
changes made.
Reason for deletion or status change from adverse to favorable:
Authorized Signature:
Date:
Please Print Name:
Telephone:
Form 2006--8-90 USA
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