Request for Credit Report

Date: ____________________
_________________________
_________________________
_________________________
[name and address of credit bureau]

To Whom It May Concern:

Please send me a copy of my credit report.
Full name: ___________________________
Date of birth: _______________________	Social Security number: _________________
Spouse's name: _____________________	Telephone number: ____________________
Current address: __________________________________________________
Previous address: __________________________________________________
[check one]:
[   ] I was denied credit on __________________ by __________________________. Enclosed is a copy of the rejection letter.
[   ] I hereby certify that I am unemployed and intend to apply for a job within the next 60 days. Enclosed is a copy of a document verifying my unemployment.
[   ] I hereby certify that I receive public assistance/welfare. Enclosed is a copy of my most recent public assistance check as verification.
[   ] I hereby certify that I believe there is erroneous information in my file due to fraud.
[   ] I live in _________________. I am requesting my annual complimentary credit report. Enclosed is a copy of a document identifying me by my name and address.
[   ] I am not entitled to a free copy of my report. Enclosed is a copy of a document identifying me by my name and address and a check for $_______.
Thank you for your attention to this matter.

Sincerely,

___________________________________________________
Signature