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CREDIT REPORT FORM
FAX #: (250) 344-2117
MEMBER NAME(S): SOCIAL INSURANCE NUMBER(S):
FIRST & LAST
STREET ADDRESS:
ARE YOU CURRENTLY WORKING? YES NO
MAILING ADDRESS:
DATE(S) OF BIRTH:
YOUR EMPLOYER:
DAY / MONTH / YEAR
CITY:
PROVINCE:
British Columbia
YOUR CONTACT NUMBER:
I/We hereby consent to Columbia Valley Credit Union obtaining a credit information report on me from a consumer reporting agency. NOTE: This consent also allows information on a spouse to be included in any report. Please fax the completed form to 250 344-2117.
SIGNATURES
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_____________________ DATE SIGNED
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_____________________ DATE SIGNED