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AUTHORIZATION TO ACCESS CREDIT REPORT INFORMATION

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AUTHORIZATION TO ACCESS CREDIT REPORT INFORMATION Powered By Docstoc
					                         THE HOMEOWNERSHIP RESOURCE CENTER
                                    4925 Lacross Rd, Suite 215
                                 North Charleston, SC 29406-6513
                       843.744.1348 • 843.744.2886 (F) • 800.232.6489

           AUTHORIZATION TO ACCESS CREDIT REPORT INFORMATION

I/We hereby authorize Consumer Credit Counseling Services (CCCS), a division of
Family Services, Inc., to access my/our credit information stored at one or more credit
repositories.

I fully understand the following: (Please initial)

____     This will appear on my credit bureau report as an inquiry.

____     The Credit Bureau Repositories will NOT allow a copy of this report to be given to me
         personally, but I/we may request a copy from the repositories.

____     CCCS does not guarantee the accuracy of the information reported on the credit report
         nor the analysis done by the counselor.

____     I/We agree that any disputes regarding the accuracy or completeness if said information
         will be directed to the source Repository (Transunion, Experian, Equifax).

____     I/We give permission for the National Foreclosure Mitigation Counseling (NFMC),
         program administrators and/or their agents to pull my credit report up to two additional
         times between now and June 30, 2010 and to give authorization for NFMC program
         administrators and/or their agents to follow-up with me between now and June 30, 2010
         for the purposes of program evaluation.

                                               PLEASE PRINT

NAME: __________________________                           SPOUSE: __________________________
SS #: ____________________________                                        __________________________
DATE OF BIRTH               _____/_____/_____                             _____/_____/_____


ADDRESS: _____________________________________________________________




SIGNATURE: _____________________                           SIGNATURE: _______________________
DATE: ___________________________                                                  _______________________

                           FAMILY SERVICES, INC.
ALLIANCE FOR CHILDREN AND FAMILIES NATIONAL FOUNDATION FOR CREDIT COUNSELING
      TRIDENT UNITED WAY GEORGETOWN UNITED WAY HORRY UNITED WAY
                ACCREDITED BY: COUNCIL ON ACCREDITATION OF SERVICES FOR FAMILIES AND CHILDREN
                      CERTIFIED BY: U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
              MEMBER OF: SOUTH CAROLINA COALITION AGAINST DOMESTIC VIOLENCE AND SEXUAL ASSAULT

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