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Credit Report Form

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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:                           YOUR CONTACT NUMBER:

                                                British Columbia


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



_________________________________________                                        _____________________
SIGNATURE                                                                        DATE SIGNED



_________________________________________                                        _____________________
SIGNATURE                                                                        DATE SIGNED

				
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Description: This is an example of credit report form. This document is useful for studying credit report form.