CONSUMER CREDIT and BACKGROUND REPORT RELEASE FORM PLEASE READ CAREFULLY

BY MY SIGNATURE BELOW I AUTHORIZE REFERENCES-ETC. to obtain a Consumer Credit Report and/or a Background Report on me. This authorization is valid for purposes of verifying information given pursuant to employment, leasing, rental, business negotiations, or any other lawful purpose covered under the Fair Credit Reporting Act. (FCRA)

By my signature below, I hereby authorize all corporations, former employers, credit agencies, educational institutions, law enforcement agencies, city, state, county and federal courts and agencies, military services and persons to release all information they may have about me including criminal, credit, and driving history. This authorization shall be valid in original or copy form.

Applicant's Name _____________________________________________________

Signature ____________________________________________________________

Date _________________________________________________________________