County Credit

Authorization to Release Credit Information

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I authorize County Credit Corp and its authorized agents to obtain a standard factual data credit report through a credit reporting agency chosen by County Credit Corp.

The undersigned, jointly and severally, represent and warrant to County Credit Corp that the information submitted in this authorization is true, correct and complete in all materials respects. The information provided does not omit any material fact or matter that makes the information or documentation presented misleading.

Any reproduction of this “Authorization to Release Credit Information” made by reliable means (for example, photocopy or facsimile) is considered an original.

Client’s Signature:

Name:

SS#:

DOB:

Address:

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