Synchrony Bank

OH3-1033
P.O. Box 8726
Dayton, OH 45401

WILLIAMS,ADRIEN     
73 VALLEY BROOK DR
DALLAS, GA 30132    

Dear WILLIAMS,ADRIEN:

Thank you for your recent credit application for the PAYPAL on 10/09/2019.

For your protection and to confirm your identity, we require additional information prior to establishing your
account. We appreciate your understanding and cooperation in completing this enhanced verification process.

We have attached a verification form to be completed only at a Bank or Credit Union. *Applicants in Puerto
Rico may utilize an attorney to notarize this affidavit and if the account is approved, the account will be credited
$25.00 to offset the fee for this service. Please complete the following steps;

 Take the attached form to a bank branch or credit union

 Request assistance from the notary at the branch
 Complete the verification form in the notary’s presence
 Have the form notarized
 Return the form via FAX to 1-866-876-6909 or mail it to:

Synchrony Bank
PO Box 8726
Dept: OH3 – 1033
Dayton, OH 45401

Upon receipt of your properly completed verification form, we will finalize the application process.

If you fail to return the completed form in 30 days from the date on this letter, your application will be declined as
we cannot confirm your identity.

Protecting your identity is a priority for Synchrony Bank. Thank you for your cooperation in completing this
process.

Synchrony Bank
ALL PERSONS TO WHOM THIS LETTER IS ADDRESSED

Please direct any inquiries concerning this notice to the creditor whose name and address is located in the
upper left hand corner of the reverse side.

Requests for a copy of your credit report should be sent to the credit reporting agency listed on the reverse
side. If no agency is listed, a credit report was not utilized in making this decision.

The Federal Equal Credit Opportunity Act prohibits creditors from discriminating against credit applicants on
the basis of race, color, religion, national origin, sex, marital status, age (provided the applicant has the
capacity to enter into a binding contract), because all or part of the applicant’s income derives from any public
assistance program or because the applicant has in good faith exercised any right under the Consumer Credit
Protection Act.

Creditor: Synchrony Bank. The federal agency that administers compliance with this law concerning this
creditor is the Consumer Financial Protection Bureau, 1700 G Street NW., Washington, DC 20006.

Creditor: Retail Finance Credit Services, LLC. The federal agencies that administer compliance with this law
concerning this creditor are the Consumer Financial Protection Bureau, 1700 G Street NW., Washington, DC
20006 and the Federal Trade Commission, Equal Credit Opportunity, Washington, DC 20580.

Under the federal Fair Credit Reporting Act, if a consumer reporting agency or agencies is identified in this
letter, you have the right (i) to obtain, within 60 days from your receipt of this letter, a free copy of
a consumer report on you from the identified agency or agencies and (ii) to dispute the accuracy or
completeness of any information on you in a consumer report furnished by the consumer reporting agency or
agencies.

OHIO RESIDENTS: The Ohio laws against discrimination require that all creditors make credit equally
available to all credit worthy customers and that credit reporting agencies maintain separate credit histories on
each individual
upon request. The Ohio Civil Rights Commission administers compliance with this law.

OM654400
R041714
 AFFIDAVIT OF IDENTITY
State of ____________________________
County of ___________________________

I, ____________________________being duly sworn, do hereby depose and attest that:

1. My full and legal name is _________________________________________

2. My current address is ____________________________________________
3. My Social Security number is ______________________________________
4. My date of birth is _______________________________________________
5. As proof of identity, I have presented the notary the following photo ID:
 US Driver’s License or State ID Number _________________
State of Issuance______________ Exp. Date_____________
 Passport Number ___________________________________
Country of Issuance ____________________ Exp Date____________
6. I applied for _________________________ account issued by Synchrony Bank
7. I swear that all the aforementioned information is true.

______________________________
AFFIANT
Name and address of Bank or Credit Union___________________________________________
_____________________________________________________________________________

Name of Notary ___________________________________________________________

Direct Business Phone Number of Notary_________________________________________

Subscribed and sworn to before me this ________day of ___________, 20____

_________________________________________(Notary Public)
________________________________________County
My commission expires___________________

*Applicants in Puerto Rico may utilize an attorney to notarize this affidavit and if the account is approved, the
account will be credited $25.00 to offset the fee for this service.