INFORMATION DISCLOSURE AUTHORIZATION

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Print this form and fax or mail to the address below

TO WHOM IT MAY CONCERN: I / We hereby authorize the release of information to Allied Mortgage Banking, it's successors, and/or assigns, or any approved credit reporting agency, for verification purposes, any information concerning:

  • Employment History: dates, title, hours worked, salary & bonus
  • Banking and Savings accounts of record
  • Mortgage loan ratings and any information associated with my/our mortgage and payment of record
  • Any other information deemed necessary in connection with a consumer credit report for a real estate transaction

This information is for confidential use in compiling mortgage loan credit information for Allied Mortgage Banking. A photographic or carbon copy of this authorization (being a photographic or carbon of the signature(s) of the undersigned) may be deemed to be the equivalent of the original and may be used as a duplicate original. Your prompt reply will help expedite my real estate transaction. Thank you for your cooperation.

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Borrower's Signature

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Borrower's Printed Full Name

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Co-Borrower's Signature

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Co-Borrower's Printed Full Name

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Borrower's Social Security Number




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Co-Borrower's Social Security Number

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Borrower's Home Address (Address, City, State, Zip Code)

There is an $18 fee to pull your credit report. Please make a check payable to Allied Mortgage or provide your credit/debit card number below. All credit card information will be destroyed immediately after processing.

Credit / Debit Card # ________________________________________

Expiration Date ____________________________________________

Trista Hopkins, MBA
Director's Mortgage 4550 SW Kruse Way, Suite 275 Lake Oswego, Oregon 97035
Phone (503) 709-1731 Fax (503) 296-2342