CREDIT REPORT AUTHORIZATION AND RELEASE

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CREDIT REPORT AUTHORIZATION AND RELEASE Authorization is hereby granted to _________________________________________________________ to obtain a standard factual data credit report through a credit reporting agency chosen by ____________________________________________ . My signature below authorizes the release to the credit reporting agency a copy of my credit application, and authorizes the credit reporting agency to obtain information regarding my employment, savings accounts, and outstanding credit accounts (mortgages, auto loans, personal loans, charge cards, credit unions, etc). Authorization is further granted to the reporting agency to use a photostatic reproduction of this authorization if necessary to obtain any information regarding the above mentioned information. Applicants hereby request a copy of the credit report obtained with any possible derogatory information be sent to the address of present residence, and holds _________________________________________________________ and any credit reporting organization harmless in so mailing the copy requested. Any reproduction of this credit report authorization and release made by reliable means (for example, photocopy or facsimile) is considered an original. Borrower's Signature Date Borrower's Signature Date Borrower's Signature Date Borrower's Signature Date GENESIS 2000, INC. * W15.0 * (800) 882-0504 Form CRAR (03/95)

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