Credit Report Review Authorization Form

First Name:*

Middle Initial:

Last Name:*

Date of Birth:*

Address Line 1:*

Address Line 2:

City:*

Zip Code:*

Phone Number:*

Email:*

SSN #:*

By signing below, I authorize employees of Credit Counseling of Arkansas (CCOA) to access a copy of my Experian credit report for the purpose of a Credit Report Review. I understand that any fee that I pay is for the review services, and not for the credit report itself. The purpose of the review service is to have the counselor explain the following:

The basic components of the credit report.
How creditor payments are listed on the report.
What items could be interpreted as positive or negative.
The basic features of the Fair Credit Reporting Act, which govern the credit reporting industry.
Methods used to improve the credit report, including, but not limited to paying off account balances, disputing inaccurate listings, and writing letters of explanation for unfavorable, but true listings. CCOA is not a “credit repair” service, and will not recommend disputing unfavorable report listings that are known to be accurate

Changing items on a credit report can be demanding, time-consuming work. My counselor will instruct/coach me on how I can undertake these efforts on my own. My counselor will provide me with letter templates that I can adapt to my needs. However, I do not expect the counselor to write letters or make dispute calls for me. The purpose of the Credit Report Review is to identify areas of possible concern, and give me the skills to resolve credit problems on my own.

I have read and I understand the disclosures made above. Signature:

Printed Name:*

Printed Date:*

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