Credit Card Form
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2Credit Report Dispute Form
If you feel there are inaccuracies in your Credit Report, you must contact each of the three major credit reporting agencies in whose
report the information appears. Please complete this form and send to the addresses below (as applicable) along with two forms of ID:
one copy of a government-issued identification card (such as a driver’s license or a state or military ID card); and one copy of a utility
bill, bank or insurance statement.
Remember, there is no charge for submitting a dispute. And for your safety, do not include original copies of the documents you use to
support your dispute.
Print the name and account number of the creditor in question in the Creditor Name/Account Number fields. Check off or clearly print the specific
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reason for your dispute. (For additional disputes, enter the information on the back of this page.)
Creditor Name ______________________________________________ Account Number __________________________________________
Dispute Reason(s)
Not My Account
Account Status Not Correct
Late Payments
Paid in Full
Identity Theft
Incorrect Balance (Approx. Correct Balance) _________________
Other (Explain) _________________________________________________________________________________________________
Creditor Name ______________________________________________ Account Number __________________________________________
Dispute Reason(s)
Not My Account
Account Status Not Correct
Late Payments
Paid in Full
Identity Theft
Incorrect Balance (Approx. Correct Balance) _________________
Other (Explain) _________________________________________________________________________________________________
Enter Additional Information to be Corrected (For Example: Name, Address, Employer):
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Clearly fill out all the information below, then sign the form where indicated.
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First Name____________________________ Middle ______________________________ Last_________________________________
Jr. ____ Sr. _____
Date of Birth (MM/DD/YYYY)_____________/________/ ________
Address _______________________________________________________________________________________________________
City ______________________________________________________________ State _____________ Zip ______________________
Previous Address (if moved within the past two years) ______________________________________________________________________
City ______________________________________________________________ State _____________ Zip ______________________
Telephone Number __________________________________________________
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Social Security Number (Necessary to Access Your Credit Reports)
Signature__________________________________________________________ Date________________________________________
Remember to make a copy for your records.
Mail the entire form to either TransUnion, Equifax or Experian, using the appropriate address listed below. To file online, you can enter one of the following
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Web addresses listed below in your browser window.
TransUnion®, 2 Baldwin Place, P .O. Box 2000, Chester, PA 19022, or
TransUnion:
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Equifax®, P .O. Box 740256, Atlanta, GA 30374, or
Equifax:
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https://
xperian®, P .O. Box 9701, Allen, TX 75013, or
Experian:
E
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