Print This Page, Complete The Form And Fax To 334-215-4437

 

To Whom It May Concern

 

Please accept my authorization and approval to release any and all credit information to Autrey Capital Group, LLC ( “APA” ) and to various lending sources and/or bonding companies as determined by APA for the purpose of deciding whether, or not to extend credit to the undersigned. The credit information includes, but is not limited to information obtained from various credit bureaus, Dun & Bradstreet, banks, finance companies, bonding companies, employers and trade. This includes method of payment, credit terms, length of credit history, high credit, current balance, work in process and collateral description.

Company Name (If applicable)____________________________________________________

 

FIN (If Applicable)_______________________________________________________________

 

Print Name____________________________________________________________________

 

Signature______________________________________________________________________

 

Social Security Number_________________________________________ Date_____________