CREDIT BUREAU SERVICES, INC.

 Date: 

 TO:     Credit Bureau Services, Inc.                            Fax: 954-567-1441

 FROM: _______________________________________________
                             (PRINT your name here)  

I am an independent loan originator approved by and through

___________________________________________________________________________
Name of Mortgage Company

 I personally guarantee payment of all fees and charges owed Credit Bureau Services, Inc. and you have my permission to pull my credit report.

  Name: _________________________________________________________

  Street: _________________________________________________________

  City, State & Zip :  ________________________________________________

  Home Telephone: ________________________________________________

  Office Telephone:   ________________________________________________

  Cell Phone: _____________________________________________________

  Fax: __________________________________________________________

  Social Security No:  ______________________________________________

  Email: _________________________________________________________

  X

Signature and Date   Please sign and date on the line above

Please fax this form to 954-567-1441 along with a copy of your driver's license or other acceptable form of photo ID.  If you do not provide an ID, your application will not be processed..  If your credit is okay, we will bill you monthly for your credit report charges.  If your credit is not okay, you will have to pay by credit card.  

Thank you!  We appreciate your business!

3503 N. Dixie Hwy, Oakland Park, FL  33334

954-561-1400            FAX:  954-567-1441

www.credit1400.com