Tenant’s Dispute
(Please Print) NAME: First ___________________________________ Middle __________________________________ Last ____________________________________ Suffix __________________________________ SOCIAL SECURITY #: ________________________ ADDRESS: ____________________________________ ____________________________________ ____________________________________ ____________________________________ DATE OF BIRTH: ____________________
Pursuant to my rights as a debtor/consumer, I submit the following Dispute pursuant to the Fair Credit Reporting Act, PL 91-508, as amended, for recording and re-publication. TYPE OF REPORT: a. Court Record: __________________________________________________ b. Rental History: __________________________________________________ c. Other History: ___________________________________________________ DATE OF REPORT: _____________________________ The basis/reason for my dispute with this creditor/consumer reporting agency is as follows: (Attached extra sheets if needed.)
____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________
______________________________________________ Signature
YOU MUST FILL OUT THIS FORM COMPLETELY OR TENANT-NET WILL NOT BE ABLE TO PROCESS YOUR DISPUTE. IT MUST BE SIGNED, PROVIDE YOUR SOCIAL SECURITY NUMBER, THE NAME OF THE CREDITOR/CONSUMER REPORTING AGENCY OR INDIVIDUAL WHICH PROVIDED THE DISPUTED INFORMATION, AND THE DATE OF THE DISPUTED REPORT/HISTORY.