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9/15/2011

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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