Credit Report Authorization Form

The undersigned hereby consent(s) to WASHER SPECIALTIES use of non-business consumer credit reports on the undersigned in order to further evaluate the credit worthiness of the undersigned as principal, proprietor, and/or
guarantor in connection with the extension of business credit as completed by this credit application. The undersigned hereby authorize(s) WASHER SPECIALTIES to utilize a consumer credit report on the undersigned from time to time
in connection with the extention or continuation of the business credit represented by this credit application. The undersigned indiviual(s) hereby knowingly consent to the use of such credit reports consistent with the Federal
Fair Credit Reporting Act as contained in U.S.C. @ 1681 et seq.
Full Name *
Social Security # *
Today's Date (mm/dd/yy) *
Company Name
Company Address
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