REAL ESTATE RENTAL FORM
Application and Verification

REASON FOR NON-ACCEPTANCE               

FROM:                                                                                                      

Date:    _________________________

Dear:                                                                                                          

Your request for tenancy has been denied for the reason(s) indicated below:

DISCLOSURE OF USE OF INFORMATION OBTAINED FROM OUTSIDE SOURCE

(if you were turned down because of information provided by a third party, that party or agency is listed below)

Information was obtained from:

_____________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________           

Under the Fair Credit Reporting Act, you have the right to make a written request, within 60 days of receipt of this notice, for disclosure of the nature of the adverse information.  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 creditors is the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.