Print this entire form then fill it out being sure to sign and date where indicated. Once you have completed this fax back to: 952-546-1009. Again this service is FREE!
CREDIT CHECK CONSENT
I, the undersigned consumer, direct to obtain a copy of my credit reprot. This consent shall automatically expire thirty (30) days from the date of my signature.
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Printed Name Social Security Number
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Signature / Date
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Printed Name Social Security Number
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Signature / Date
*The second signature line is only to be used when ordering a JOINT credit report for a married couple. If more than one individual credit report is being ordered, use a seperate Credit Check Consent form for each customer.
Name: Name:
Work Phone: Work Phone:
Home Phone: Home Phone:
E-mail: E-mail:
Marital Status: Marital Status
Birth Date: Birth Date:
Ages of Dependent Children: Ages of Dependent Children:
Current Home Address: Current Home Address:
City, COUNTY, State, Zip: City, COUNTY, State, Zip:
Own or Rent AND Start Date: Own or Rent AND Start Date:
Monthly Payment: $ Monthly Payment: $
If less than two (2) years please attache a note for previous residences.
Employer Company Name or Self Employed Employer Company Name or Self Employed
Address: Address:
Date you started: Date You Started:
Your Title: Your Title:
Your GROSS monthly income (before taxes): $ Your GROSS Monthly Income (before taxes): $
Type of Business: Type of Business:
Years you have in this type of work: Years you have in this type of work:
We will need two (2) full years of employment & rent history with written explanations of any gaps.
Continue employment & rent history on an additional page.
ASSETS PLEASE INDICATE JOINT OR INDIVIDUAL (IF INDIVIDUAL INDICATE BORROWER 1 OR 2)
Checking - Institution & Current Balance: $ Savings - Institution & Current Balance: $
City, State City, State
Account Number: Account Number:
Other - Institution & Current Balance: $ Other - Institution & Current Balance: $
City, State City, State
Cash value stocks, bonds securities: $ Cash value life insurance: $
Company Name Company Name
Tax refund due: $ Retirement fund (vested) company name: $
Net worth of business owned: $ Other:
Percentage of business owned: %
LIABILITIES PLEASE INDICATE IF JOINT OR INDIVIDUAL (IF INDIVIDUAL INDICATE BORROWER 1 OR 2)
Monthly child support / care / alimony we will need a copy of the decree)
Landlords Name(s) Address(es) Phone Number(s) for past two years use additional sheet(s) if necessary
List ANY and ALL other real estate presently owned, use additional sheet(s) if necessary
If ANY of the above properties are rental what is the rental income(s): $
Are you refinancing an existing property or purchasing a new one?
If you are purchasing (and have selected a property) what is the FULL address:
Property Identification number (PID) [From MLS Listing or property tax records]:
Will the title be held Jointly / In Common / Individually:
Purchase Price or Current Value if Refinancing: $ Year Home Built:
Source of and amount of cash to close (including down payment): $
Are there any judgements, delinquent debts, or have you filed bankruptcy or had a foreclosure (in the past 7 years), or defaulted on ANY Federal debt or any other debt:
Are you a US Citizen Resident Alien: Do you intend to occupy the property as your primary residence:
Have you had ownership interest in property in the last three (3) years: What type of property did you own - principal (PR) Second Home (SH) or investment property (IP):
How did you hold title - sole by yourself (S) jointly with your spouse (SP) jointly with another (O):
AGREEMENT
Verification may be obtained from any source named in this pre-qualification form and from a credit reporting agency.
We the undersigned intend to occupy the property as our primary reisdence / do not intend to occupy the property as our primary residence. (Cross out that portion that does NOT pertain to you useage).
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