Dear __________________

Enclosed is a photocopy of ____________________ (name) signed authorization for disclosure of credit information. Would you be kind enough to supply the information requested below. We have provided you with a copy of this request for your files.

Please return the original in the enclosed, postage paid envelope.

Name of Applicant: __________________________________

Address: ___________________________________________

City, State, Zip: _____________________________________

Length of time of Credit Account: _____________________

Highest Credit Extended: _____________________________

Credit Limit: ________________________________________

Average Monthly Balance: ____________________________

Balance Now Due: ___________________________________

Balance Past Due: ___________________________________

Normal Paying Habits: _______________________________

Remarks:___________________________________________