Request for Credit Info on New Account

Enclosed is a photocopy of [name] 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:
Very truly yours,