Date:________________________________

To:__________________________________



Please be advised I have a credit account with your firm and hereby request that a report of my credit history with you be forwarded to the below listed credit reporting agencies. You may consider this letter as my authorization to release this information.

Thank you for your cooperation


_____________________________________
Signature

_____________________________________
Social Security Number

_____________________________________
Address

_____________________________________


_____________________________________
Signature of Joint Applicant (if any)

_____________________________________
Name of Account

_____________________________________
Account Number

Credit Reporting Agencies/Company

___________________________________ _____________________________________
Agency/Company Agency/Company

___________________________________ _____________________________________
Address Address

___________________________________ _____________________________________


___________________________________ _____________________________________
ATTN: ATTN: