Consumer'S Rights Form

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Consumer’s Rights
FCRA Amendment – Section 615
Name ______________________________________________________________________________________________________
Address ____________________________________________________________________________________________________
City ______________________________________________ State _______________________________ Zip Code ____________
This notice is to inform you that your application has been:
___ Rejected
___ Approved with conditions
__ Residency requires an increased security deposit
__ Residency requires last month’s rent
__ Residency requires a qualified guarantor
__ Residency requires an increased monthly rent of $___________
__ Other _____________________________________________________________________________________________
Adverse action on your application was based on the following:
___ Information contained in a consumer credit report.
___ The consumer report did not contain sufficient information.
___ Information received in a criminal record.
___ Information received in a civil record.
___ Information received from an employment verification.
___ Information received from previous rental history or reference.
___ Other ___________________________________________________________________________________________________
A copy of A Summary of Your Rights Under the Fair Credit Reporting Act is included with this notice.
The company below only provided information about your history and took no part in making the decision to reject your rental
application and is unable to supply you with specific reasons why the decision was made. You have a right under the Fair Credit
Reporting Act to know the information contained in your credit file at the consumer-reporting agency. You have a right to a free copy
of your report from the reporting agency, if you request it no later than 60 days after you receive this notice. In addition, if you find
that any information contained in the report you receive is inaccurate or incomplete, you have the right to dispute the matter with the
reporting agency.
Credit Information: TransUnion Consumer Relations, 2 Baldwin Place, PO Box 1000, Chester, PA 19022. Phone: 800-888-4213.
Criminal, Civil and Rental History: Orca Information, Inc., PO Box 277, Anacortes, WA 98221. Phone: 800-341-0022.
or
Credit Score Disclosure
___ We did not receive a credit score.
___ We obtained a copy of your credit score from TransUnion Consumer Relations, 2 Baldwin Place, PO Box 1000, Chester, PA
19022. Phone: 800-888-4213.
Your credit score is a number that reflects the information in your credit report. Your credit score can change, depending on how the
information in your credit report changes. Your credit score was __________________. Scores range from a low of 150 to a high of
950. Key factors that adversely affected your credit score:
__ Failure to make payments on time
__ Limited credit experience
__ Recent collection action or judgment
__ Foreclosure or repossession
__ Too many credit inquiries
__ Other _____________________________________________________________________________________________
DATED this ______________________________ day of __________________________________, 20___.
________________________________________
________________________________________
AGENT/OWNER Signature
AGENT/OWNER Signature
Para information en español, visite o escribe a la FTC Consumer Response Center, Room 130-A 600
Pennsylvania Ave. N. W., Washington, D. C. 20580.

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