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Please Note: This version of the "Application Denial and Adverse Action Letter" is for use with Rental Properties outside of the City of Portland, Oregon ONLY.
To switch to the City of Portland version of this form click the button below.


Required entries are indicated by blue icons or *


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

Screening Charge Returned: 

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

If Applicant submitted Supplemental Information to mitigate possibly negative screening results, the following is an explanation of the reasons that Supplemental Information did not adequately compensate for the factors that informed Owner/Agent's decision to reject the Application:

If you were not previously provided an opportunity to submit Supplemental Evidence, you may contact Owner/Agent to request that opportunity.

You have the right to request from us, in writing within 60 days of receiving this letter, the nature of that information.

If you believe the information received regarding your rental history, criminal history, or income was inaccurate, you have the right to appeal this determination by submitting a request in writing to Owner/Agent and providing evidence to contradict the negative outcome. A successful appeal does not guarantee residency.

The consumer reporting agency that provided the report was:

PO Box 7404256
Atlanta, GA 303764-0256

Dispute Department
P.O. Box 9701
Allen, TX 75013

Trans Union
Consumer Solutions
P.O. Box 2000
Chester, PA 19022-2000

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 www.annualcreditreport.com 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.


Please Note: Signature field must be filled in and signed after printing.

Owner/Agent Signature:   Date:

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PO Box 20862, Keizer, OR 97307
eMail: office@oregonrentalhousing.com