[Your name]
[Account Number at Institution if available]
[Date of birth or other identifying information requested by company]
[Your return address] [Date]
[Financial Institution Name]
[Financial Institution address for receipt of direct disputes]
Re: Error[s] on consumer checking account screening report.
Dear [Name of financial institution],
I am writing to request a correction of the following information that appears on my [name of checking
account reporting company] consumer report:
Dispute 1 [The following examples are meant to be helpful, include all disputes that apply]
Account Number or other information to identify account to the company: [Insert account number or
other information such as account holder names and past addresses. This is important especially if
you have had multiple accounts with the same company.]
Dates associated with item being disputed: [Insert the date that appears on your report. This helps
ensure that the correct account is identified by the financial institution and to identify which aspects
of the report are being disputed. You can still file a dispute if you don’t have this date.]
Explanation of item being disputed: [Insert a detailed explanation of why the information is
inaccurate. Choose one of the choices below if it fits, or add your own description.]
The report shows I owed money to the bank that I have already repaid. [Give info about when
you paid, and attach a copy of any proof that you have.]
The report shows that I was suspected of fraudulent activity but I was the victim of a scam and
not the perpetrator.
I’m the victim of identity theft and I don’t recognize one or more of the accounts on my report.
[You may wish to include a copy of the FTC identity theft affidavit describing the identity theft.]
Other [Describe what is wrong with the report. You may include copies of any additional
supporting documentation that you have.]
Dispute 2 [Continue numbering for each disputed item on your report and include the same information]
Thank you for your assistance.
Sincerely,
[Your name]