#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