Authorization to Pull Credit Information Form

[ORGANIZATION NAME and ADDRESS]

Authorization to Pull Credit Information

I am a candidate for the Individual Development Account (IDA) program and as part of the application process, [organization] may verify any information in my application or in other documents required in connection with the program, either before or after applying to the program.

I authorize [organization] to pull an annual TransUnion credit report and credit score on my behalf through an agreement with Credit Builder’s Alliance, starting on the month I applied and for 3 additional years. For example, by signing below I give [organization] permission to pull a copy of my TransUnion credit report and score on January 2013, January 2014, January 2015, and January 2016.

Please complete the following information:

Last Name First Name Middle Initial

Social Security Number Date of Birth Drivers License #

Current Address City State CA Zip

If the above address is less than 3 years old, please complete the following

Previous Address City State Zip

Previous Address City State Zip

CREDIT DISCLOSURE

In compliance with the fair credit reporting act, this is to inform you that you are authorizing this organization and/or its affiliates to obtain an investigative consumer credit report. You have the right to dispute the information on this report and request additional disclosures provided under section 606§1681d(b) of the fair credit reporting act, and a written summary of your rights pursuant to section 609(c). You may do this by contacting the provider of this information. Please call onecreditsource.com at 1 (800) 905-9678 and you will be directed to the proper credit reporting agency or assisted in your inquiry. You also release from liability any persons involved in the credit investigation.

I certify, to the best or my knowledge, that all statements above are true and complete. I further authorize The Los Angeles Community Reinvestment Committee d.b.a. CFRC and its affiliates to obtain any and all information related to credit information related to applying to The Los Angeles Community Reinvestment Committee d.b.a. CFRC’s IDA program.

Signed Date