Demand For Placement Of Statement In Credit Bureau Report

A demand for a consumer who is dissatisfied with the results of a credit bureau's investigation as to a complaint made by the consumer, for the inclusion of this statement in the report.

CREDIT BUREAU:

ADDRES:

Dated: _______________.

Pursuant to the Fair Credit Collection Act and other applicable laws and regulations, I have previously requested that you investigate the following. Despite the results of your investigation, I am not satisfied and request that you add the following statement (or if required by law a summary) to my report:

DISPUTE ERRONEOUS ENTRY

I, [NAME] CONSUMER DID NOT FAIL TO PAY HEALTH CLUB MEMBERSHIP; THE ACTUAL DEFAULTING HEALTH CLUB MEMBER WAS [NAME] CUSTOMER, SSN _______________.

Identification information:

NAME:

PRESENT ADDRESS:

ZIP CODE:

LENGTH OF TIME AT PRESENT ADDRESS:

EMPLOYER:

DATE OF BIRTH:

SOCIAL SECURITY NUMBER:

__________________________

CONSUMER

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