Rental Application Denial and Adverse Action Notice Template

A notice for an applicant who is denied, or approved only on tougher terms, because of a consumer report, a credit score or information from someone else. It covers the disclosures the Fair Credit Reporting Act requires.

Use this template

Download PDF Download Word (DOCX)

Free, no sign up. Fill it in by hand or edit the Word file.

General template, not legal advice. Have an attorney in your state review before use.

General information, not legal advice. This template is a starting point. Laws differ by state and city, so have a licensed attorney review your final document before you use it.

Last reviewed October 29, 2026

Before you use it

If a consumer report or credit score played any part in a denial, or in approval on worse terms, the Fair Credit Reporting Act requires an adverse action notice.
The notice must name the reporting agency, say it did not make the decision, and explain the free report and dispute rights.
If a credit score was used, the notice must also give the score, the score range, the key factors, the date and the source.
Information from a past landlord or employer triggers a separate right to ask what it was.

Read the full guide to this form

How to fill it in

Underlined spaces are blanks to fill in. The small label says what goes there.
Shaded boxes mark rules that change by state. Look up the rule where the property is located.
Delete clauses that do not apply, and add any disclosures your state or city requires.

General template, not legal advice. Have an attorney in your state review before use. Last reviewed October 29, 2026.

Rental Application Denial and Adverse Action Notice

When to send it: send this notice whenever you deny an application, ask for a larger deposit, a cosigner or higher rent, or take any other step that is less favorable than you offered, and the decision was based in whole or in part on a consumer report (such as a credit, eviction or criminal background report) or on a credit score. Complete Part 3 when information from a source other than a consumer reporting agency, such as a past landlord or employer, played a part. Fill in every blank. Check the boxes that apply.

Date of notice
Applicant name
Applicant mailing address
Applicant email
Property applied for
Date of application

Dear Applicant name,

Thank you for applying to rent the property listed above. We have reviewed your application. This notice tells you about our decision and about your rights.

Part 1: Our decision

Your application has been denied.
Your application has been approved on the following conditions, which differ from the terms we offered: Conditions, such as a higher deposit, a cosigner or higher rent
Other action: Describe

Part 2: Information from a consumer reporting agency

Our decision was based in whole or in part on information in a consumer report about you from the consumer reporting agency named below.

Consumer reporting agency name
Mailing address
Phone number (toll free if the agency compiles files nationwide)
Website

The consumer reporting agency did not make this decision and cannot tell you the specific reasons for it.

You have the right to get a free copy of your report from the consumer reporting agency named above if you ask for it within 60 days after you receive this notice. You also have the right to dispute with that agency the accuracy or completeness of any information in the report it gave us. The agency must investigate a dispute and correct or delete information that is inaccurate, incomplete or cannot be verified.

Credit score used (complete if a credit score was used)

We also used a numerical credit score in making our decision. A credit score is a number that sums up your credit history and estimates how likely you are to repay debts. Details of the score we used:

Your credit score
Range of possible scores (lowest to highest)
Date the score was created
Who provided the score

Key factors that hurt your score, in order of importance (list up to four, or five if the number of recent inquiries was one of them):

#	Key factor
1
2
3
4
5

Part 3: Information from another source (complete if it applies)

Our decision was based in whole or in part on information we got from a person or company other than a consumer reporting agency, such as a past landlord, an employer or a reference. You have the right to ask us to tell you what that information was. To do so, send us a written request within 60 days after you receive this notice, and we will tell you the nature of the information within a reasonable time after we receive your request.

Part 4: Other reasons (optional)

The written rental criteria we apply to every applicant are available on request. Other reasons that played a part, if any: Reasons based on your written criteria, such as income below the stated requirement or incomplete application

State or local screening rules: Check the rule in your state

Fair housing: we do not make housing decisions based on race, color, religion, sex (including sexual orientation and gender identity), national origin, familial status, disability or any other characteristic protected by federal, state or local law. Your state or city may protect additional characteristics, such as source of income.

Questions about this notice can be sent to Landlord or agent name at Address, phone and email.

Landlord or agent signaturePrinted nameDate

Delivery record (keep with the application file)

Date sent
Method (mail, email, portal, in person)
Sent by
Copy of consumer report retained until (follow your records policy and secure disposal rules)

General template, not legal advice. Have an attorney in your state review before use.

More free templates.

All resources

Ready to run it for real? Start the 14-day free trial or book a demo.