Form RD 410-8 RD 410-8 Applicant Reference Letter

U.S. DEPARTMENT OFAGRICULTURE
Rural Development

Form RD 410-8
(Rev, 7-09)

FORM APPROVED
OMB NO. 0575-0091

APPLICANT REFERENCE LETTER
(A Request for Credit Reference)

We are considering an application for a Ioan from the applicant
listed below. We ~vould appreciate you giving us the benefit of
your knowledge and/or experience with the applicant’s credit
history to enable us to better evaluate the application.

F

Please return the original of this form to the requesting
office address below. A postage paid envelope is enclosed.

SIGNATURE AND TITLE NAME

NAME OFAGENCYANDADDRESS OF REQUESTING OFFICE

SIGNATURE OF APPLICANT

NAMEANDADDRESS OFAPPUCANT

ALL hVFORM,4T[ON PROVIDED WILL BE RELEASED TO APPLICANT AT APPLICANT’S REQUEST
RELATIONSHIP W1TH APPLICANT
INDICATE THE NUMBER OF YEARS YOU HAVE:
KNOWN APPLICANT
DONE BUSINESS WITH
APPLICANT
~]EMPLOYER
[] LANDLORD [] BUSINESS [] CREDITOR
HIGHESTAMOUNTAPPLICANT AMOUNT APPLICANT
PRESENTLYOWES YOU
HASOWEDYOU
$
$
IS APPLICANT CURRENT IN
REPAYMENTTOYOU? ......................................
[] YES
RATE APPLICAN]~S PROMPTNESS IN MAKING PAYMENTS:
30 DAYS
INDICATE NUMBER OF TIM ES
PAYMENTS WERE LATE IN THE
LAST 24 MONTHS.

APPLICANT’S REPAYMENT SCHEDULE

[] NO

YOUR SECURITY FOR DEBTS
NOW OWED BYAPPLICANT

IF NO, INDICATE AMOUNT
DELINQUENT

60 DAYS

90 DAYS

WOULDYOUEXTEND
FURTHERCREDtTTO
APPLICANT?
[~YES

[~NO

USE THIS SPACE TO INCLUDEANY COMMENTS YOU WISH TO MAKE CONCERNING YOUR CREDIT EXPERIENCE W1THAPPLICANT

DATE

TITLE (If a business firm)

SIGNATURE (Your signature acknowledges receipt of
statement required by the Privacy Act of 1974)

According to the Pape~ork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
i~tformation unless it displays a valid OivlB control numbe~ The valid OMB control nttmber for this information collection is 0575-009t. The time
required to complete this information collection is estimated to average 6 minutes per response, including the time for revie*¢ing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing attd revimving the collection of #foralagion.

This certifies that the U.S. Department of Agriculture has complied with the applicable provisions of Title XI~ the "Right to Financial Privacy Act 1978"
Public Law 95-630 in seeking financial information regarding the above nmned applicant.

SEE ATTACHED PRIVACY ACT NOTICE

Pasi~on 3
U3NITED STATES DEP.A~RTMENT OF AGRICULTURE
Rura! Development

PRIVACYACT STATEMENT TO REFERENCES

Rural Development is authorized by the Consolidated Farm and Rural Development Act (7 U.S.C. 1921
et. seq.); and Title V of the Housing Act of 1949, as amended (42 U.S.C. 1471 et. seq.), to solicit the
information requested.
Disclosure of the information requested is voluntary. However, information provided is of considerable
value to the Agencies in determining the re,oayment ability of individuals and thek eligibility for Agency
programs. There will be no consequences to you if you do not provide the information requested.
Your name, mad the information you provide, will be released to the applicant at the applicant’s request.
Some information will be available to any requestor under the provisions of the Freedom of Information
Act.
The information you provide may be referred to another agency, whether Federal, State, local or foreign,
charged with the responsibility of investigating or prosecuting a violation of law; or of enforcing or implementing the statue, role, regulation, or order issued pursuant thereto, of any record within this system when
information available indicates a violation of law, whether civil, criminal or regulatory in nature, and ~vhether
arising by general statue or particular program statue, or by rule, regulation or order issued pursuant
thereto.

Rural Development is a Equal Opport~mity Lender
Complaints" of discrimination based on race, sex, religion,
naiional origin or martial status should be sent to:
Secretary of Agriculture, Washington, D. C. 20250.