Credit Report Dispute Form
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1Credit Report Dispute Form
Simply fill in the form, sign your name, include a copy of the page of your credit report that you are
disputing and any documentation (see below), then mail the form to us at the address listed below.
Contact Information
Name:_____________________________________________ Birth Date:_________________
Address:_____________________________________________________________________
City:______________________________________State:_________________Zip:__________
Social Security Number:_________________________ Phone:__________________________
Dispute Information
Account Number:___________________________ Type of Account: CARD
First Name on Account: ______________________________________________
This information is inaccurate because:
This is not my account.
_
I am a victim of identity theft.
_
I have never paid late.
_
This account is in bankruptcy.
_
This account is closed.
_
I have paid this account in full.
_
I paid this before it went to collection or before it was charged off.
_
Other:_________________________________________________________________
_
Have you previously made this dispute: YES / NO
If yes, please explain: ___________________________________________________
Signature: __________________________________________________Date:_____________
Please include a copy of the page of your credit report that contains the item you are disputing.
DO NOT SEND YOUR ENTIRE CREDIT REPORT
Documentation
Please include photocopies of documentation you may have that supports your dispute. Some
examples are:
•
For a bankruptcy: Chapter 7, 11, or 13 papers
•
For a divorce: divorce agreement or other document showing the division of assets
•
For identity theft: police report and/or affidavit(s)
•
Cancelled checks:
•
Correspondence about the account.
•
If you have spoken to us about the account, the name of the Commerce employee and date of the
conversation
•
If you are disputing account ownership: a copy of state- issued ID or Social Security card with Social
Security Number
Mail
Credit Bureau Dispute Representative
P.O. Box 411036
Kansas City, MO 64141-1036
Fax#: 816-234-2811
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