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FORM #43 - Application Denial & Adverse Action Letter

  • Applicant(s):
  • Address: Unit:
  • City: State: Zip:
  • Rental Unit Address: Unit:

Your application to rent the property did not meet our screening guidelines for the following reasons:

  • ___ Negative or insufficient rental history
  • ___ Negative or insufficient reports from references or other sources
  • ___ An eviction within the past five years that resulted in a general judgment for the Owner/Agent
  • ___ An eviction action that is still pending
  • ___ Inaccurate or false information on the application
  • ___ Unacceptable criminal history that includes a drug-related crime, a person crime, a sex offense, a crime involving financial fraud, including identity theft and forgery, or any other crime of a nature that would adversely affect the property of the Owner/Agent, or the health, safety or right to peaceful enjoyment of the premises of residents or Owner/Agent.
  • ___ Inability to verify information
  • ___ Insufficient income
  • ___ The property was rented to someone else
  • ___ Failure to meet other screening guidelines: __________________________________________

Screening Charge Returned: ___ Yes ___ No ___ N/A

Because your application did not meet our standards, we are:

  • ___ Denying your application ___ Requesting an increased deposit and/or co-signer
  • ___ If checked, the adverse action taken was based in whole or in part on information received from a person or company other than a consumer reporting agency. You have the right to request from us, in writing within 60 days of receiving this letter, the nature of that information.
  • ___ If checked, the adverse action taken was based in whole or part on a credit report. The consumer reporting agency that provided the report was (check one of the three):

CBI Equifax Credit Information
PO Box 105851
Atlanta, GA 30348

Experian (formerly TRW)
PO Box 2002
Allen, TX 75013

Trans Union Consumer Relations
PO Box 1000
Chester, PA 19022

While the consumer reporting agency listed above provided information about your credit or history, it took no part in making the decision regarding your application, nor can it explain why adverse action was taken.

Under the Fair Credit Reporting Act (15 USC 1681j), you have the right to obtain a copy of your consumer credit report. To obtain a free copy, you must request it within 60 days of the date you receive this letter by writing or telephoning the consumer reporting agency checked above. You may also go to to view all three of your credit profiles free of charge.

If you believe any information in your report is incorrect, you have the right to dispute the accuracy or completeness of the information and to put into your report a consumer statement of up to 100 words explaining your position on the item under dispute. Trained personnel are available to help prepare consumer statements.

You also have certain rights under credit reporting and consumer protection laws in Oregon. For further information, you should contact a consumer protection agency or the Attorney General's office.

Owner/Agent Signature: ___________________________ Date: __________________

  • Owner/Agent:
  • Address:
  • City: , State: Zip:
  • Telephone: Email:


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1462 Commercial St. NE, Salem, OR 97301
Phone: 503-364-5468 | Fax: 503-585-8119

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