Please complete this form in its entirety.
Full Name __________________________________________________________________
Social Security Number ______________________________
Driver’s License Number ______________________________
City, State, ZIP ______________________________________________________________
Driver’s License State ________________________________
Place of Employment ________________________________________________________
Home Phone ________________________________________
Date of Birth ______________________________________________________________
Work Phone ________________________________________
TG reports to the three national credit bureaus listed below. Please mark which bureau’s report you are disputing:
Account number(s) as listed on credit report _______________________________________________________________________________________________
PLEASE PROVIDE A COPY OF THE CREDIT REPORT THAT SUPPORTS YOUR DISPUTE.
Please check the appropriate box(es) which best describes the information you believe to be incorrect:
❏ Reported As $ ______________
Should Be $ ________________
❏ Account Paid Off
❏ Not Reported
List payment dates (provide cancelled check copy)
❏ Not Past Due
❏ Last Payment Date______________________________________________________________
Credit Status Incorrect:
❏ Reported As ________________
Should Be __________________
❏ Not My Loan
❏ Other: (describe below)
Provide as many details as you can, accompanied with appropriate documentation to support your dispute:
If your dispute is based on possible fraud, please provide a copy of your driver’s license and social security card.
I state under penalty of perjury that the statements I have made on this request are true and accurate to the best of my knowledge.