Free adverse action notice 42Free adverse action notice 42
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Adverse Action Notice
Date:
Member's Name:
Member's Address:
Description of Account, Transaction, or Requested Credit:

Member/Account Number:

ACTION TAKEN AFFECTING CREDIT REQUEST OR EXISTING CREDIT
Date of Loan Request:

Amount of Loan Requested: $
Your credit has been terminated for the following account:

We are unable to process your application because we
require the following information to make a decision:

We are unable to extend credit on the terms you requested
but can offer credit on the following terms:

If we do not receive this information by
we will be unable to consider your application.
We are unable to extend credit to you at this time.
Your credit limit has been decreased to $
We are unable to honor your request to increase your credit limit.

If this offer is acceptable to you, please notify us no later than
at the address at the top of this notice.

Other:

ACTION TAKEN AFFECTING SHARE DRAFT/CHECKING OR OTHER ACCOUNT OR SERVICE
At this time we are unable to offer