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8406.BLD
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1993-01-06
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59 lines
#8406
@001 Enter the name of the applicant:
@840 Enter the social security number of applicant:
@841 Enter the date of the application:
@002 Enter the name of prospective creditor:
@843 Enter name of person to reply to at creditor:
@844 Enter the street address of the prospective creditor:
@845 Enter the city, state of the prospective creditor:
@846 Enter the telephone number of prospective creditor:
#end control section
#8406
/* Para. 8404: Applicant's release of information */
AUTHORIZATION FOR RELEASE OF INFORMATION
Name of applicant: @001
Social security number: @840
Date of application: @841
TO: Employers, Credit References
You are authorized to release information concerning my
employment or credit history with you to @002.
You are further released from liability in connection with your
response to this inquiry.
A photocopy of this authorization will be as effective as an
original.
___________________________________________
@001
@002
Attention: @843
@844
@845
Telephone: @846