Credit Dispute Form
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Creditor |
Client |
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Name: _____________________________________ |
Name: _____________________________________ |
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Address:___________________________________ |
Address: ___________________________________ |
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__________________________________________ |
___________________________________________ |
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Account #__________________________________ |
Daytime Phone: ______________________________ |
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Evening Phone: ______________________________ |
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Date of Birth: ________________________________ |
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Social Security #______________________________ |
To Whom It May Concern:
Please note that the following changes should be made on the above referenced account.
- This account does not belong to client
This account was included in bankruptcy
(Enclosed schedule of debtors and discharges) - Account is paid in full
(Enclosed receipt) - Other______________________________________________________
Comments _________________________________________________________
Please notify me in writing when this matter is corrected
Sincerely, __________________________________________________________
