Credit Check Authorization Form

January 18, 2010

in Authorization Forms

A credit check authorization forms grants a person permission to check the card holder’s financial capability by requesting a financial report of his credit details.  This form can be filled by anyone with a credit card when required to do so by people they relate with professionally e.g. landlord, employer or a financial institution that intends to have financial dealings with the card holder.

APPROVAL TO ACQUIRE CREDIT REPORT

Full Name: _______________________________________ Date of Birth: _____________________

Social Security Number: ______________________________ Driver’s License Number ____________

Phone: __________________________________ Email: _________________________________

Address: ______________________________________ Town: _________________________________

Zip: ___________________________________   State: __________________________________

Credit card information

Account number _______________________________________ Expiry date ________________

Billing address _________________________________________________________________________

City___________________  State_________________ Zip code __________________

Phone_________________  Email ____________________ Fax _______________________

I hereby consent to:

Full Name: _______________________________________ Date of Birth: _____________________

Social Security Number: ______________________________ Driver’s License Number ____________

Phone: __________________________________ Email: _________________________________

Address: ______________________________________ Town: _________________________________

Zip: ___________________________________   State: __________________________________

To obtain my credit records for dates between ___________________ and ______________________.  I agree that I will be notified in writing on the results of this credit check.

Name _______________________________________________________________________________

Signature ____________________________________ Date ___________________________________

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