1234, Main Street
Boston, MA 02123
04 April, 2005
<Recipient Address Goes Here>
I recently received a copy of my credit report from your agency. On that report, you show that my account with <name of creditor> <was/is> <description of status>. I wish to dispute this entry on my report on the grounds that <your reason for the dispute>. Please check with <name of creditor> to verify the validity of this entry on my credit report.
I look forward to hearing from you.
encl: <List of enclosed items goes here>