INFORMATION DISCLOSURE AUTHORIZATION

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TO WHOM IT MAY CONCERN:

I/We hereby authorize you to release to Dominion Mortgage Corporation for verification purposes information concerning:

__X___  Employment history, dates, title, income, hours worked, etc.

__X___  Banking, including but not limited to, all checking and savings accounts of record.

__X__  Mortgage loan rating, opening date, high credit, payment amount, loan balance, interest rate, and payment record.

__X___  Any information deemed necessary in connection with a consumer credit report for a real estate transaction.

This information is for the confidential use of the lender in completing a mortgage loan application.

A photographic or carbon copy of this authorization may be deemed to be the equivalent of the original and may be used as a duplicate original.

 
Your prompt reply will expedite my real estate transaction.

 

 

                                                                       
Name (Print)

 

 

                                                                       
Address

 

                                   
Date

                                                                       
City, State, Zip

 


                                                  
Social Security Number

___________________

Borrower Signature


                                                                       
Name (Print)

 



                                                                       
Address

                                   
Date

                                                                       
City, State, Zip

 


                                                 
Social Security Number

___________________

Borrower Signature