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April 6, 2016

Name of information holder

Address
Address2
City, State/Province
Zip/Postal Code

OBJECT: AUTHORITY TO RELEASE CREDIT-RELATED INFORMATION

Dear [CONTACT NAME],

The undersigned hereby authorizes the disclosure and release of any and all personal credit-related
information in your possession, including but not limited to credit, financial, salary, banking, debt and tax
information and materials, to [FIRM NAME], as required, until further notice. This authorization is valid for
[NUMBER] days from the date of my signature below. Please keep a copy of my release request for your
files.

Thank you for your co-operation.

Dated: [DATE]

[WITNESS] [NAME OF CREDIT APPLICANT]

Company Name
Street, City, State/Province, Zip/Postal code Tel: (000) 000-0000 / Fax: (000) 000-0000
www.yourwebsite.com