| Requester Information |
| First Name: |
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| Last Name: |
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| Address Street 1: |
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| Address Street 2: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| Co-Requester Information |
| First Name: |
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| Last Name: |
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| Contact Information |
| Daytime Phone: |
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| Evening Phone: |
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| Email: |
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| Financial Information |
| Loan Type: |
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| Property Information |
| Property Type: |
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| Occupancy: |
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| Purchase Price: |
(USD) |
| Appraised Value: |
(USD) |
| Mortgage Balance: |
(USD if applicable) |
| Other Information |
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Authorization to release credit report
By signing below, I/we hereby authorize Bill Huggins to obtain a consumer credit report through a credit reporting agency.
I/We understand and agree that Bill Huggins intends to use the consumer credit report for purposes of evaluating my/our financial readiness to buy/refinance a home.
I/We understand that this credit report will be retained on file with Bill Huggins and that the information will not be disclosed to anyone without my written consent.
If the permission being granted is received via email, my/our typed name(s) below represents said authorization.
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