Dear
Enclosed is a photocopy of Mr. Smith's signed authorization
for disclosure of credit information. Would you be kind
enough to supply the information requested below. We have
provided you with a copy of this request for your files.
Please return the original in the enclosed, postage paid
envelope.
Name of Applicant: __________________________________
Address: __________________________________
City, State, Zip: __________________________________
Length of time of Credit Account:
Highest Credit Extended:
Credit Limit:
Average Monthly Balance:
Balance Now Due:
Balance Past Due:
Normal Paying Habits:
Remarks:
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