ADVERSE ACTION NOTICE(This is a multipurpose form, and only those parts with the

heading checked apply to your loan application or account.)

Name and Address of Applicant Date of Notice Date of Loan Request

Account Number Dollar Amount Requested

Description of Account, Transaction or Requested Credit

NOTICE OF INCOMPLETE APPLICATION AND REQUEST FOR ADDITIONAL INFORMATIONThe following information is needed to make a decision on your recent application:

The credit union must receive this information by______________________________________________________________________. If the information isnot received by that date, we will be unable to give further consideration to your request.

STATEMENT OF DENIAL, TERMINATION OR CHANGE

Description of action taken by credit union:Refusal to grant loan Change in loan account that is unfavorable to borrower Refusal to grant ATM or Check CardRefusal to grant Credit Card Refusal to honor requested increase in credit available Termination of ATM or Check Card Termination of loan account Other ________________________________________________________________________________________________

PRINCIPAL REASON(S) FOR DENIAL, TERMINATION OR OTHER ACTION TAKEN (See Equal Credit Opportunity Act Notice below.)

DISCLOSURE OF USE OF INFORMATION OBTAINED FROM AN OUTSIDE SOURCE

Our decision was based in whole or in part on information obtained in a report from the consumer-reporting agency listed below. You have a right under the FairCredit Reporting Act to know the information contained in your file at the consumer-reporting agency by requesting a free copy of your consumer report from themno later than 60 days after receipt of this notice. The reporting agency played no part in our decision and is unable to supply specific reasons why we have deniedyour request. You have a right to dispute the accuracy or completeness of any information in a consumer report furnished by the consumer-reporting agency.

_______________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _______________________________________

We also obtained your credit score from ____________________________________ and used it in making our credit decision. Your credit score is a numberthat reflects the information in your consumer report. Your credit score can change, depending on how the information in your consumer report changes.

Your credit score: ________ Date: ________________ Scores range from a low of ________ to a high of ________

Key factors that adversely affected your credit score:

__________________________________________________________ __________________________________________________________

__________________________________________________________ __________________________________________________________

Number of recent inquiries on consumer report, as a key factor

If You have any questions regarding Your credit score, You should contact ____________________________________ at:

Address: _____________________________________________________________________ Telephone Number: __________________________

Our decision was based in whole or in part on information obtained from an affiliate or from an outside source other than a consumer-reporting agency. Under the FairCredit Reporting Act, you have the right to make a written request no later than 60 days after receipt of this notice, for disclosure of the nature of this information.

COUNTER OFFER

Although we are unable to approve this transaction on the terms you requested for the reason(s) noted above, we can make the following offer instead:

If this alternative offer is acceptable to you, please notify us no later than __________________________ at the credit union's address that is shown at thetop of this notice. (date)

Equal Credit Opportunity Act NoticeThe federal Equal Credit Opportunity Act prohibits creditors from discriminating against applicants on the basis of race, color, religion, national origin, sex, marital status, age(provided that 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; orbecause the applicant has in good faith exercised any right under the Equal Credit Opportunity Act. The federal agency that administers compliance with this law concerningthis credit union is: Federal Trade Commission, Atlanta Regional Office, Suite 5M35, 60 Forsyth Street, S.W., Atlanta, Georgia 30303-2322

Copy Mailed Or Delivered By:________________________________________________________________________________________________________Signature Date

Copyright Oak Tree Business Systems, Inc ., 2006-2011. All Rights Reserved. OTBS 086Y (7/11)CSCU (7/11)

Community South Credit Union1044 Hwy. 90 EastChipley, FL 32428(866) 638-8376Fax: (850) 638-4055