[Full Name]
[City, State Zip]

RE:  Letter Requesting Authorization to Release Credit Information 

Dear [Mr., Mrs., Ms., Dr. Last Name]:

Thank you for your recent interest in establishing credit with our company. 

Please sign the authorization below to release credit information and complete the enclosed form. Then submit it to us with your most recent financial statement.

We will contact your credit and bank references and then contact you regarding credit with our company.



[Credit Manager] 

I, _____________________________________, recently applied for credit with ______________________________________.  I have been requested to provide information concerning my credit history.  Therefore, I authorize the investigation of my credit information. 

Your release of my credit information is authorized whether such information is of record or not.  I release you and all persons, agencies, agents, employees, firms, companies, or parties affiliated with you from any damages resulting from providing such information.

This authorization is valid for thirty (30) days from the date of my signature below. Please keep a copy of my release request for your files.

Thank you in advance for your cooperation.

Signature: ______________________________          Date: _______________ 

Address: _________________________________________________________

Telephone (day): ___________________________

Telephone (evening): ___________________________