AOA Form No. 142 Rev. 04/06) Copyright 2006 Apartment Owners Association of California www.aoausa.com
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AOA National Credit Alert Report
This form is for the reporting of one person only. Additional occupants and/or other debtors must be completed on a
separate form. AOA will cause the information below to be reported to the credit reporting agencies, but does not warrant
the time of, form of, or fact of inclusion into the consumer’s credit profile. Any existing tenancies or any debts older than 6
½ years should not be reported.
Please enclose payment of $8.00 payable to AOA for each debtor to be reported.
Mail to: AOA, 6445 Sepulveda Blvd. #300, Van Nuys, CA 91411
Your Name/Company Name: _________________________________________________________________________
Your Mailing Address:_______________________________________________________________________________
Telephone: __________________________________________ Fax:_________________________________________
Please Type or Print Clearly
Date of Birth
[ ] This is a new report of a derogatory.
[ ] This is an update of a previous reported derogatory.
Date debt originated: _______________
Amount owed: $_______________
The law requires that the consumer be notified anytime before, or within 30 days after, you report a derogatory to
a Credit Reporting Agency in substantially the following words: “You are hereby notified that a negative credit
report reflecting on your credit record may be submitted to a credit reporting agency if you fail to fulfill the terms
of your credit/rental obligations.” Only one notification to the consumer is necessary.
Have you given the debtor written notice that this debt can be repor