Authorization to Release Credit Information

AUTHORIZATION TO RELEASE CREDIT INFORMATION

Date:             ___________________________________

To:                ___________________________________

Account #:     ___________________________________

As a holder of the above referenced credit account with your firm, I (we) hereby authorize and request that a report detailing my (our) credit history with your firm be forwarded to the following companies and/or credit reporting agencies listed at the bottom of this page.  Please be advised, this letter serves as my (our) authorization for the release of my (our) credit history information with your firm.  Thank you for your cooperation in this matter.


___________________________________    ___________________________________
Signature                                                    Signature of Joint Applicant (if any)

___________________________________    ___________________________________
Social Security Number                               Social Security Number

___________________________________    _____________________________________
Address, Line 1                                           Address, Line 1

___________________________________    _____________________________________
Address, Line 2                                           Address, Line 2