PERSONAL CREDIT CHECK AUTHORIZATION

I authorize Weiss & Mueller, Ltd., to run and obtain a personal credit report on myself for the purpose of its client making a credit decision. I agree to hold Weiss & Mueller, Ltd. and its client harmless regarding any information that is obtained during this credit check. I am aware that this report is prepared under the guidelines of the Fair Credit Reporting Act (FCRA) and I am eligible to receive, upon written request, a copy of the report, if not approved.

Applicant: The request for your date of birth is to be used in performing a credit check only, and is not used by the client in consideration of credit worthiness.

If you have a signed authorization, type your initials here
Signature on file

CLIENT INFORMATION
Date:
Last Name:
Middle Name:
Maiden Name:
Address:
City:
State:
Social Security Number:
Date of Birth:
Client & Location:
Email:
Submitted By:
Contact #: