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Please Note: This version of the "Portland Application Denial and Adverse Action Letter" is for use with Rental Properties within the City of Portland, Oregon ONLY.
To switch to the standard Oregon State 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:

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

The consumer reporting agency that provided the report was:

PO Box 7404256
Atlanta, GA 30374-0256

Experian Dispute Department
PO Box 9701
Allen, TX 75013

Trans Union Consumer Solutions
PO 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 htps://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.

If you feel this adverse action or denial was made in whole or in part on misinformation received in the screening process, you have the right to know more specifically, the basis for the denial, and correct, refute or explain the negative information by submitting a Written Appeal within 30 days to Owner/Agent’s address below. After further consideration of this appeal, Owner/Agent will notify you of their decision to uphold the denial or adverse action, or re-open your Application. If your Application is re-opened upon appeal, you have specific rights enumerated by the Portland Housing Bureau visit https://www.portland.gov/code/30/01/086 for more information.

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