Applicant____________________

Address______________________

City_________________________

Loan No._____________________

Gentlemen:

I have applied for a ____________ (form of loan) loan to be made by ____________ (name of lending institution).

I shall appreciate your completing the Deposit Verification for their confidential use and forwarding it to,

(Name of institution) ______________________________________

(Address) ______________________________________

(City, state, zip) ______________________________________

Statement of account ______________________________________ Type of account ______________________________________

Balance ______________________________________

Date ______________________________________

Thank you for your consideration and prompt reply, as it will avoid many delays.

Very truly yours,

________________________

VERIFICATION OF BANK OR OTHER DEPOSITORY

Is Above Statement Approximately Correct? _____________

If “No”, please give Current Balance _____________

Date Account Opened _____________

Approximate Average Balance for Past 2 Months _____________

Loans Outstanding To Applicant:

Secured Date of Loan__________ Current Balance ________

Unsecured Date of Loan__________ Current Balance_______

This information is furnished to you in strict confidence in response to your request and is solely for use by you in connection with the above application for a loan.

____________ _________________________ _______________________

Date Official Title Signature