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
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.
NAME: __________________________ SPOUSE: __________________________
SS #: ____________________________ __________________________
DATE OF BIRTH _____/_____/_____ _____/_____/_____
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
D:\Docstoc\Working\pdf\09fefd3c-dff6-47bf-83be-d9c7d02037cf.doc Rev Date 9/22/12