Name of applicant: Enter the name of the applicant
Social security number: Enter the social security number of applicant
Date of application: Enter the date of the application
TO: Employers, Credit References
You are authorized to release information concerning my employment or credit history with you to Enter the name of prospective creditor.
You are further released from liability in connection with your response to this inquiry.
A photocopy of this authorization will be as effective as an original.
Enter the name of the applicant
Enter the name of prospective creditor
Attention: Enter name of person to reply to at creditor
Enter the street address of the prospective creditor
Enter the city, state of the prospective creditor
Telephone: Enter the telephone number of prospective creditor