DIY Legal Forms

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Request For Copy Of Credit Bureau Report

(Note: This form letter requests the disclosure of all information in a Credit Bureau report to you or your personal representative.)

Credit Company:



Pursuant to the Fair Credit Collection Act and other applicable laws and regulations, I request full disclosure of the nature and substance of all information (except medical) on me in your files, including the sources of the information (except investigative sources) and a listing of the recipients of any reports you furnished about me within the last [6] six months (or the last [2] two years if furnished for employment purposes).

This request is made because of credit, insurance, employment denied or adversely modified to me within the last [--] days by [Name] Department Store. This report is required by law to be at no charge.


Present Address:

Length of time at present address


Date of Birth:

Social Security Number:

I understand the credit bureau will inform me in advance of any charges resulting from this interview for which I am properly responsible to pay.

I certify under the penalties of perjury and the civil penalty described that I am the person named above and I understand that federal law provides that a person who obtains information from a consumer reporting agency under false pretenses shall be fined not more than [$------] or imprisoned not more than one year, or both.

I authorize the bureau named above to review my credit record with me in the presence of [Name], who has furnished reasonable identification to the credit bureau.