ECOA Model Forms

Form C-1—Sample Notice of Action Taken and Statement of Reasons
Statement of Credit Denial, Termination or Change
Date:____________________
Applicant’s Name:____________________
Applicant’s Address:____________________
Description of Account, Transaction, or Requested Credit:____________________
Description of Action Taken:____________________
Part I—Principal Reason(s) for Credit Denial, Termination, or Other Action Taken
Concerning Credit
This section must be completed in all instances.
___ Credit application incomplete
___ Insufficient number of credit references provided
___ Unacceptable type of credit references provided
___ Unable to verify credit references
___ Temporary or irregular employment
___ Unable to verify employment
___ Length of employment
___ Income insufficient for amount of credit requested
___ Excessive obligations in relation to income
___ Unable to verify income
___ Length of residence
___ Temporary residence
___ Unable to verify residence

___ No credit file
___ Limited credit experience
___ Poor credit performance with us
___ Delinquent past or present credit obligations with others
___ Collection action or judgment
___ Garnishment or attachment
___ Foreclosure or repossession
___ Bankruptcy
___ Number of recent inquiries on credit bureau report
___ Value or type of collateral not sufficient
___ Other, specify: _____
Part II—Disclosure of Use of Information Obtained From an Outside Source
This section should be completed if the credit decision was based in whole or in part on
information that has been obtained from an outside source.
___ Our credit decision was based in whole or in part on information obtained in a report
from the consumer reporting agency listed below. You have a right under the Fair Credit
Reporting Act to know the information contained in your credit file at the consumer reporting
agency. The reporting agency played no part in our decision and is unable to supply specific
reasons why we have denied credit to you. You also have a right to a free copy of your report
from the reporting agency, if you request it no later than 60 days after you receive this notice. In
addition, if you find that any information contained in the report you receive is inaccurate or
incomplete, you have the right to dispute the matter with the reporting agency.
Name:____________________

Address:________________________________________
[Toll-free] Telephone number:____________________
[We also obtained your credit score from the consumer reporting agency and used it in
making our credit decision. Your credit score is a number that reflects the information in your
consumer report. Your credit score can change, depending on how the information in your
consumer report changes.
Your credit score: ________________
Date: __________________________
Scores range from a low of ________ to a high of _________.
Key factors that adversely affected your credit score:
__________________________
__________________________
__________________________
__________________________
[Number of recent inquiries on consumer report, as a key factor]
[If you have any questions regarding your credit score, you should contact [entity that
provided the credit score] at:
Address: ____________________
[[Toll-free] Telephone number: _________________]
___ Our credit decision was based in whole or in part on information obtained from an affiliate
or from an outside source other than a consumer reporting agency. Under the Fair Credit
Reporting Act, you have the right to make a written request, no later than 60 days after you
receive this notice, for disclosure of the nature of this information.

If you have any questions regarding this notice, you should contact:
Creditor’s name:____________________
Creditor’s address:____________________
Creditor’s telephone number:____________________
Notice: The federal Equal Credit Opportunity Act prohibits creditors from discriminating
against credit applicants on the basis of race, color, religion, national origin, sex, marital status,
age (provided the applicant has the capacity to enter into a binding contract); because all or part
of the applicant's income derives from any public assistance program; or because the applicant
has in good faith exercised any right under the Consumer Credit Protection Act. The federal
agency that administers compliance with this law concerning this creditor is (name and address
as specified by the appropriate agency listed in Appendix A).
Form C-2—Sample Notice of Action Taken and Statement of Reasons
Date
Dear Applicant: Thank you for your recent application. Your request for [a loan/a credit
card/an increase in your credit limit] was carefully considered, and we regret that we are unable
to approve your application at this time, for the following reason(s):
Your Income:
___ is below our minimum requirement.
___ is insufficient to sustain payments on the amount of credit requested.
___ could not be verified.
Your Employment:
___ is not of sufficient length to qualify.
___ could not be verified.

Your Credit History:
___ of making payments on time was not satisfactory.
___ could not be verified.
Your Application:
___ lacks a sufficient number of credit references.
___ lacks acceptable types of credit references.
___ reveals that current obligations are excessive in relation to income.
Other:____________________
The consumer reporting agency contacted that provided information that influenced our
decision in whole or in part was [name, address and [toll-free] telephone number of the reporting
agency]. The reporting agency played no part in our decision and is unable to supply specific
reasons why we have denied credit to you. You have a right under the Fair Credit Reporting Act
to know the information contained in your credit file at the consumer reporting agency. You also
have a right to a free copy of your report from the reporting agency, if you request it no later than
60 days after you receive this notice. In addition, if you find that any information contained in
the report you receive is inaccurate or incomplete, you have the right to dispute the matter with
the reporting agency. Any questions regarding such information should be directed to [consumer
reporting agency]. If you have any questions regarding this letter, you should contact us at
[creditor’s name, address and telephone number].
[We also obtained your credit score from the consumer reporting agency and used it in
making our credit decision. Your credit score is a number that reflects the information in your
consumer report. Your credit score can change, depending on how the information in your
consumer report changes.

Your credit score: ________________
Date: __________________________
Scores range from a low of ________ to a high of _________.
Key factors that adversely affected your credit score:
__________________________
__________________________
__________________________
__________________________
[Number of recent inquiries on consumer report, as a key factor]
[If you have any questions regarding your credit score, you should contact [entity that
provided the credit score] at:
Address: ____________________
[[Toll-free] Telephone number: _________________]
Notice: The federal Equal Credit Opportunity Act prohibits creditors from discriminating
against credit applicants on the basis of race, color, religion, national origin, sex, marital status,
age (provided the applicant has the capacity to enter into a binding contract); because all or part
of the applicant’s income derives from any public assistance program; or because the applicant
has in good faith exercised any right under the Consumer Credit Protection Act. The federal
agency that administers compliance with this law concerning this creditor is (name and address
as specified by the appropriate agency listed in Appendix A).
Form C-3—Sample Notice of Action Taken and Statement of Reasons (Credit Scoring)
Date

Dear Applicant: Thank you for your recent application for _____. We regret that we are
unable to approve your request.
[Reasons for Denial of Credit]
Your application was processed by a [credit scoring] system that assigns a numerical
value to the various items of information we consider in evaluating an application. These
numerical values are based upon the results of analyses of repayment histories of large numbers
of customers.
The information you provided in your application did not score a sufficient number of
points for approval of the application. The reasons you did not score well compared with other
applicants were:
• Insufficient bank references
• Type of occupation
• Insufficient credit experience
• Number of recent inquiries on credit bureau report
[Your Right to Get Your Consumer Report]
In evaluating your application the consumer reporting agency listed below provided us
with information that in whole or in part influenced our decision. The consumer reporting
agency played no part in our decision and is unable to supply specific reasons why we have
denied credit to you. You have a right under the Fair Credit Reporting Act to know the
information contained in your credit file at the consumer reporting agency. It can be obtained by
contacting: [name, address, and [toll-free] telephone number of the consumer reporting agency].
You also have a right to a free copy of your report from the reporting agency, if you request it no
later than 60 days after you receive this notice. In addition, if you find that any information

contained in the report you receive is inaccurate or incomplete, you have the right to dispute the
matter with the reporting agency.
[Information about Your Credit Score]
[Information about Your Credit Score]
We also obtained your credit score from the consumer reporting agency and used it in
making our credit decision. Your credit score is a number that reflects the information in your
consumer report. Your credit score can change, depending on how the information in your
consumer report changes.
Your credit score:__________________
Date:_______________________
Scores range from a low of ______________to a high of _______________.
Key factors that adversely affected your credit score:
_____________________________
_____________________________
_____________________________
_____________________________
[Number of recent inquiries on consumer report, as a key factor]
[If you have any questions regarding your credit score, you should contact [entity that
provided the credit score] at:
Address: ______________________________________________
[Toll-free] Telephone number:________________]
If you have any questions regarding this letter, you should contact us at
Creditor’s Name:____________________

Address:________________________________________
Telephone:____________________
Sincerely,
Notice: The federal Equal Credit Opportunity Act prohibits creditors from discriminating
against credit applicants on the basis of race, color, religion, national origin, sex, marital status,
age (with certain limited exceptions); because all or part of the applicant’s income derives from
any public assistance program; or because the applicant has in good faith exercised any right
under the Consumer Credit Protection Act. The federal agency that administers compliance with
this law concerning this creditor is (name and address as specified by the appropriate agency
listed in Appendix A).
Form C-4—Sample Notice of Action Taken, Statement of Reasons and Counteroffer
Date
Dear Applicant: Thank you for your application for _____.We are unable to offer you
credit on the terms that you requested for the following reason(s):____________________
We can, however, offer you credit on the following terms: ________________________
If this offer is acceptable to you, please notify us within [amount of time] at the following
address: _____.
Our credit decision on your application was based in whole or in part on information
obtained in a report from [name, address and [toll-free] telephone number of the consumer
reporting agency]. You have a right under the Fair Credit Reporting Act to know the
information contained in your credit file at the consumer reporting agency. The reporting agency
played no part in our decision and is unable to supply specific reasons why we have denied credit
to you. You also have a right to a free copy of your report from the reporting agency, if you

request it no later than 60 days after you receive this notice. In addition, if you find that any
information contained in the report you receive is inaccurate or incomplete, you have the right to
dispute the matter with the reporting agency.
[We also obtained your credit score from the consumer reporting agency and used it in
making our credit decision. Your credit score is a number that reflects the information in your
consumer report. Your credit score can change, depending on how the information in your
consumer report changes.
Your credit score:__________________
Date:_______________________
Scores range from a low of ______________to a high of _______________.
Key factors that adversely affected your credit score:
_____________________________
_____________________________
_____________________________
_____________________________
[Number of recent inquiries on consumer report, as a key factor]
[If you have any questions regarding your credit score, you should contact [entity that
provided the credit score] at:
Address: ______________________________________________
[Toll-free] Telephone number:

]

You should know that the federal Equal Credit Opportunity Act prohibits creditors, such
as ourselves, from discriminating against credit applicants on the basis of their race, color,
religion, national origin, sex, marital status, age (provided the applicant has the capacity to enter

into a binding contract), because they receive income from a public assistance program, or
because they may have exercised their rights under the Consumer Credit Protection Act. If you
believe there has been discrimination in handling your application you should contact the [name
and address of the appropriate federal enforcement agency listed in Appendix A].
Sincerely,
Form C-5—Sample Disclosure of Right To Request Specific Reasons for Credit Denial
Date
Dear Applicant: Thank you for applying to us for _____.
After carefully reviewing your application, we are sorry to advise you that we cannot
[open an account for you/grant a loan to you/increase your credit limit] at this time. If you
would like a statement of specific reasons why your application was denied, please contact [our
credit service manager] shown below within 60 days of the date of this letter. We will provide
you with the statement of reasons within 30 days after receiving your request.
Creditor’s Name
Address
Telephone Number
If we obtained information from a consumer reporting agency as part of our consideration
of your application, its name, address, and [toll-free] telephone number is shown below. The
reporting agency played no part in our decision and is unable to supply specific reasons why we
have denied credit to you. [You have a right under the Fair Credit Reporting Act to know the
information contained in your credit file at the consumer reporting agency.] You have a right to a
free copy of your report from the reporting agency, if you request it no later than 60 days after
you receive this notice. In addition, if you find that any information contained in the report you

received is inaccurate or incomplete, you have the right to dispute the matter with the reporting
agency. You can find out about the information contained in your file (if one was used) by
contacting:
Consumer reporting agency’s name
Address
[Toll-free] Telephone number
[We also obtained your credit score from the consumer reporting agency and used it in
making our credit decision. Your credit score is a number that reflects the information in your
consumer report. Your credit score can change, depending on how the information in your
consumer report changes.
Your credit score:__________________
Date:_______________________
Scores range from a low of ______________to a high of _______________.
Key factors that adversely affected your credit score:
_____________________________
_____________________________
_____________________________
_____________________________
[Number of recent inquiries on consumer report, as a key factor]
[If you have any questions regarding your credit score, you should contact [entity that
provided the credit score] at:
Address: ______________________________________________
[Toll-free] Telephone number:

]

Sincerely,
Notice: The federal Equal Credit Opportunity Act prohibits creditors from discriminating
against credit applicants on the basis of race, color, religion, national origin, sex, marital status,
age (provided the applicant has the capacity to enter into a binding contract); because all or part
of the applicant’s income derives from any public assistance program; or because the applicant
has in good faith exercised any right under the Consumer Credit Protection Act. The federal
agency that administers compliance with this law concerning this creditor is (name and address
as specified by the appropriate agency listed in Appendix A).
Form C-6—Sample Notice of Incomplete Application and Request for Additional
Information
Creditor’s name
Address
Telephone number
Date
Dear Applicant: Thank you for your application for credit. The following information is
needed to make a decision on your application: _________________________
We need to receive this information by _____(date). If we do not receive it by that date,
we will regrettably be unable to give further consideration to your credit request.
Sincerely,
Form C-7—Sample Notice of Action Taken and Statement of Reasons (Business Credit)
Creditor’s Name
Creditor’s address
Date

Dear Applicant: Thank you for applying to us for credit. We have given your request
careful consideration, and regret that we are unable to extend credit to you at this time for the
following reasons:
(Insert appropriate reason, such as: Value or type of collateral not sufficient; Lack of
established earnings record; Slow or past due in trade or loan payments)
Sincerely,
Notice: The federal Equal Credit Opportunity Act prohibits creditors from discriminating
against credit applicants on the basis of race, color, religion, national origin, sex, marital status,
age (provided the applicant has the capacity to enter into a binding contract); because all or part
of the applicant’s income derives from any public assistance program; or because the applicant
has in good faith exercised any right under the Consumer Credit Protection Act. The federal
agency that administers compliance with this law concerning this creditor is [name and address
as specified by the appropriate agency listed in Appendix A].
Form C-8—Sample Disclosure of Right To Request Specific Reasons for Credit Denial
Given at Time of Application (Business Credit)
Creditor’s name
Creditor’s address
If your application for business credit is denied, you have the right to a written statement
of the specific reasons for the denial. To obtain the statement, please contact [name, address and
telephone number of the person or office from which the statement of reasons can be obtained]
within 60 days from the date you are notified of our decision. We will send you a written
statement of reasons for the denial within 30 days of receiving your request for the statement.

Notice: The federal Equal Credit Opportunity Act prohibits creditors from discriminating
against credit applicants on the basis of race, color, religion, national origin, sex, marital status,
age (provided the applicant has the capacity to enter into a binding contract); because all or part
of the applicant’s income derives from any public assistance program; or because the applicant
has in good faith exercised any right under the Consumer Credit Protection Act. The federal
agency that administers compliance with this law concerning this creditor is [name and address
as specified by the appropriate agency listed in Appendix A].
Form C-9—Sample Disclosure of Right To Receive a Copy of an Appraisal
You have the right to a copy of the appraisal report used in connection with your
application for credit. If you wish a copy, please write to us at the mailing address we have
provided. We must hear from you no later than 90 days after we notify you about the action
taken on your credit application or you withdraw your application.
[In your letter, give us the following information:]
Form C-10—Sample Disclosure About Voluntary Data Notation
We are requesting the following information to monitor our compliance with the federal
Equal Credit Opportunity Act, which prohibits unlawful discrimination. You are not required to
provide this information. We will not take this information (or your decision not to provide this
information) into account in connection with your application or credit transaction. The law
provides that a creditor may not discriminate based on this information, or based on whether or
not you choose to provide it. [If you choose not to provide the information, we will note it by
visual observation or surname].