Authorization

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_______________________