Rd 410-8

Form RD 410-8

U.S. DEPARTMENT OF AGRICULTURE

(Rev. 12-08)

FORM APPROVED
OMB NO. 0575-0091

Rural Development

APPLICANT REFERENCE LETTER
(A Request for Credit Reference)

We are considering an application for a loan from the applicant
listed below. We would 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.
Please return the original of this form to the requesting office
address below. A postage paid envelope is enclosed.

NAME OF AGENCY AND ADDRESS OF REQUESTING OFFICE

SIGNATURE AND TITLE NAME

DATE

NAME AND ADDRESS OF APPLICANT

SIGNATURE OF APPLICANT

ALL INFORMATION PROVIDED WILL BE RELEASED TO APPLICANT AT APPLICANT'S REQUEST
RELATIONSHIP WITH APPLICANT
EMPLOYER

LANDLORD

HIGHEST AMOUNT APPLICANT AMOUNT APPLICANT
HAS OWED YOU
PRESENTLY OWES YOU
$

CREDITOR

BUSINESS

IS APPLICANT CURRENT IN
REPAYMENT TO YOU?

YES

YOUR SECURITY FOR DEBTS
NOW OWED BY APPLICANT

APPLICANT'S REPAYMENT SCHEDULE
$

$

INDICATE THE NUMBER OF YEARS YOU HAVE:
KNOWN APPLICANT
DONE BUSINESS WITH
APPLICANT

NO

PER

WEEK

IF NO, INDICATE AMOUNT
DELINQUENT

MONTH

$

RATE APPLICANT'S PROMPTNESS IN MAKING PAYMENTS:
INDICATE NUMBER OF TIMES
PAYMENTS WERE LATE IN THE
LAST 24 MONTHS.

30 DAYS

90 DAYS

60 DAYS

WOULD YOU EXTEND
FURTHER CREDIT TO
APPLICANT?
YES

NO

USE THIS SPACE TO INCLUDE ANY COMMENTS YOU WISH TO MAKE CONCERNING YOUR CREDIT EXPERIENCE WITH APPLICANT

DATE

TITLE (If a business firm)

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

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of
information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0575-0091. The time
required to complete this information collection is estimated to average 6 minutes per response, including the time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.
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 named applicant.

SEE ATTACHED PRIVACY ACT NOTICE

UNITED STATES DEPARTMENT OF AGRICULTURE
Rural Development

PRIVACY ACT 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 Agencies in determining the repayment ability of individuals and their eligibility for Agency
programs. There will be no consequences to you if you do not provide the information requested.
Your name, and the information you provide, will be released to the applicant at the applicant's request.
Some information will be available to any requester 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 statute, rule, 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 whether
arising by general statute or particular program statute, or by rule, regulation or order issued pursuant
thereto.

Rural Development is a Equal Opportunity Lender.
Complaints of discrimination based on race, sex, religion,
national origin or marital status should be sent to:
Secretary of Agriculture. Washington D. C. 20250.