From: ________________________                         To: _________________________

_____________________________                         ____________________________

_____________________________                         ____________________________


Thank you for your interest in establishing credit with our company.  Enclosed is an authorization to release information.


Please sign the agreement below and complete the enclosed form.  The enclosed form as well as your most recent financial statements are necessary documents to complete your application.  Upon receipt we will contact your credit and bank references.  Then we will contact you regarding your credit terms with our company.




Credit Manager     




I/We authorize the investigation of my/our firm ,_____________________ and its related credit information.  I/We have been requested to provide information to _____________ for their use in reviewing our creditworthiness.


I/We authorize the release of any and all information obtained during this credit search.  I/We release any and all claims and liabilities against any and all parties involved with regards to the release of this information.


This form is valid for a period of thirty (30) days from the date below.

Signature ___________________                              Signature ____________________


Title _______________________                             Title ________________________


Date _________________                                           Date ___________________



Please keep a copy for your future reference.  Thank you.