DIY Legal Forms

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Demand For Placement Of Statement In Credit Bureau Report

(Note: 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:



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 [Company]; the actual defaulting [Company] was [name] customer, ssn _______________.

Identification Information:


Present address:

Length of time at present address:


Date of birth:

Social Security Number: