Request to Include 100-Word Consumer Statement

[CLIENT FULL NAME] [CLIENT ADDRESS LINE1] [CLIENT CITY], [CLIENT STATE] [CLIENT ZIP] Phone: [CLIENT PHONE] | Email: [CLIENT EMAIL] DOB: [CLIENT DOB] | SSN (last 4): XXX-XX-[CLIENT SSN LAST4] Date: [TODAY] [RECIPIENT NAME] [RECIPIENT ADDRESS BLOCK] Sent via Certified Mail, Return Receipt Requested: [LETTER CERTIFIED NUMBER] RE: Request to Include Consumer Statement Pursuant to FCRA Section 611(b) (15 U.S.C. § 1681i(b)) To Whom It May Concern at [BUREAU NAME], I am writing to formally request that [BUREAU NAME] include a statement of dispute in my consumer file, pursuant to Section 611(b) of the Fair Credit Reporting Act (15 U.S.C. § 1681i(b)). Despite my formal dispute regarding the account listed below, the matter remains unresolved: Disputed Creditor: [ACCOUNT CREDITOR NAME] Account Number: [ACCOUNT ACCOUNT NUMBER MASKED] Pursuant to 15 U.S.C. § 1681i(b) and § 1681i(c), please attach the following statement (under 100 words) to my consumer credit file and include it whenever this account or a consumer report containing my file is issued: "[CUSTOM NOTES]" Under 15 U.S.C. § 1681i(c), please confirm in writing that this statement has been added to my file and provide an updated copy of my report. Sincerely, ____________________________________ [CLIENT FULL NAME]