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    Adverse Action Notice

    Uploaded by

    Yvette Hernandez
    The document is an adverse action notice from a financial institution informing the recipient that their account application was denied due to information in their ChexSystems report. It explains that ChexSystems did not make the denial decision and cannot provide specific reasons. It also informs the recipient of their rights to obtain a free report copy within 60 days and dispute any inaccurate information directly with ChexSystems. The recipient is provided contact information for ChexSystems and asked to complete a form with identification and address details to help ChexSystems assist them.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Adverse Action Notice

    Uploaded by

    Yvette Hernandez
    91 views1 page
    The document is an adverse action notice from a financial institution informing the recipient that their account application was denied due to information in their ChexSystems report. It explains that ChexSystems did not make the denial decision and cannot provide specific reasons. It also informs the recipient of their rights to obtain a free report copy within 60 days and dispute any inaccurate information directly with ChexSystems. The recipient is provided contact information for ChexSystems and asked to complete a form with identification and address details to help ChexSystems assist them.

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    The document is an adverse action notice from a financial institution informing the recipient that their account application was denied due to information in their ChexSystems report. It explains that ChexSystems did not make the denial decision and cannot provide specific reasons. It also informs the recipient of their rights to obtain a free report copy within 60 days and dispute any inaccurate information directly with ChexSystems. The recipient is provided contact information for ChexSystems and asked to complete a form with identification and address details to help ChexSystems assist them.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    91 views1 page

    Adverse Action Notice

    Uploaded by

    Yvette Hernandez
    The document is an adverse action notice from a financial institution informing the recipient that their account application was denied due to information in their ChexSystems report. It explains that ChexSystems did not make the denial decision and cannot provide specific reasons. It also informs the recipient of their rights to obtain a free report copy within 60 days and dispute any inaccurate information directly with ChexSystems. The recipient is provided contact information for ChexSystems and asked to complete a form with identification and address details to help ChexSystems assist them.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    Date of Notice

    Adverse Action Notice


    NOTICE OF ACTION BASED ON INFORMATION CONTAINED IN CONSUMER REPORT
    We regret we cannot open your account today due to information received from Chex Systems, Inc., a consumer-reporting agency.
    ChexSystems did not make the decision to disapprove your account application and is unable to provide you with specific reasons why the
    decision was made.
    You have rights under state and federal laws. Included in these rights are:
    The right to obtain a free copy of your ChexSystems consumer report if you make such a request to ChexSystems within 60 days of
    your receipt of this notice; and
    The right to dispute the completeness or accuracy of any information contained in such report by notifying ChexSystems directly of
    your dispute.
    You may contact ChexSystems by visiting their web site at www.chexsystems.com, by telephone using their Voice Response Unit at 800-428-
    9623, by mail at ChexSystems, Attn: Consumer Relations, 7805 Hudson Road, Suite 100, Woodbury, MN 55125; or by fax at 602-659-
    2197.
    TO ENABLE CHEXSYSTEMS TO PROPERLY ASSIST YOU, YOU WILL NEED TO SUPPLY THEM WITH THE INFORMATION REQUESTED
    BELOW AND/OR ON THE REVERSE SIDE.
    PLEASE COMPLETE THIS FORM.

    Name 1
    (Last Name) (First Name) (Middle Name)

    Maiden Name or Other Last Names Used


    Social Security Number - - Birth Date
    (mo/day/yr)
    Home Phone #( )
    State of Issuance
    Name 2
    (Last Name) (First Name) (Middle Name)

    Maiden Name or Other Last Names Used


    Social Security Number - - Birth Date
    (mo/day/yr)
    Home Phone #( )
    State of Issuance

    Current Address
    Number and Street Apt #/P.O. Box City State Zip Code
    **ChexSystems will correspond with you at the above address unless you request otherwise**
    Any Previous Addresses Used by Name 1 or 2 In The Past Five Years (include any P.O. Boxes):
    Number and Street P.O. Box City State Zip Code

    List Name, Tax ID#, and Address of Any Business/Organization Accounts Name 1 or 2 Has Signed On in the Past Five Years:
    Business Name Your Title Tax ID Number Business Address

    Signature(s): 1 2

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