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150 North Street Suite 41
Pittsfield, MA 01201
Toll Free: 877-FIX-DEBT
877-349-3328
Local: 413-442-5538
Fax: 413-442-3268

AUTHORIZATION TO RELEASE INFORMATION

I / We hearby authorize and instruct any person or consumer reportingagency to release any and all information that may be required for thepurpose of a credit transaction.  The current information is requestedfor the use in connection with a bona fide "permissible purpose" as definedin Section 54 of Public Law 91-508. A photocopy of this authorization shallbe equivalent of the original and may be used as such.
 
 

_____________________________      ____________
Applicant                                                S.S. #

____________________________________________
Address

_____________________________      ____________
Signiture                                                  Date
 
 

_____________________________      ____________
Co-Applicant                                          S.S. #

____________________________________________
Address

_____________________________      ____________
Signiture                                                  Date
 
 

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