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11/19/2010

Authorization



Re: Loan # [#] or Savings Account # [#]

I hereby authorize release to [Name of person to receive information],
credit information for my pending credit application on a real estate
transaction.

___________________________________
(clearly print name after signature)

Loan Opened: ________________ Monthly Payments: ______________
High Credit: __________________ Current Balance: ________________
Paying Record: _______________ Savings Account: _______________
Date Opened: ________________ Present Balance: ________________

The above is furnished to you in strictest confidence to your request.

Date: _________________________

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