To: __________________________

Re: Loan ______________or Savings Account ____________,

I hereby authorize release to ___________________________, credit information for my pending credit application on a real estate transaction.

________________________
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: _______________________ _______________________
By__________________________ By_______________________