request for investigation of Experian RentBureau Rental History Report

Date: ____________________________

First name: _______________________________ MI:_______ Last name:_____________________________Gen (SR, etc.):_____

Other name(s) used for credit: _________________________________________________________________________________

Social Security number: ___________-___________-________________ Date of birth: ___________________________________

Phone number(s): ______________________________________________________________________________

Current mailing address: _________________________________________________________________________ Apt: ________

City: __________________________________________ State: __________ ZIP code: ________________

please investigate the following items on my Experian RentBureau Rental History Report

First dispute Second dispute

Company name: _______________________________________
Account number: _________________________________________
I believe this item is incorrect because (Choose only one):
Payment never late Account closed
Paid in full - On what date? ______ /______ / _________
Company name: _______________________________________
Account number: _________________________________________
I believe this item is incorrect because (Choose only one):
Payment never late Account closed
Paid in full - On what date? ______ /______ / _________

Account included in bankruptcy - Chapter: _______
Filing date: ______ /______ / _________
Not my account
Who does it belong to? ________________________________
Paid this off before it went to collections
Other - Must explain:
Account included in bankruptcy - Chapter: _______
Filing date: ______ /______ / _________
Not my account
Who does it belong to? ________________________________
Paid this off before it went to collections
Other - Must explain:

Please provide any additional documentation to assist in this investigation, such as cancelled checks, utility bills
and legal documentation. You may make copies of this form to submit additional disputes or use a separate piece of
paper. Send copies of any documentation you send to us and always retain your original documents.

contact information
Mail this form to P.O. Box 26, Allen, TX 75013; or call us at 877 704 4519.