Credit History Consent Form

CREDIT HISTORY CONSENT FORM

Client Name:   Date of Birth:

Current Address:

WHEREAS

WHEREAS, the Requesting Party identified below requires authorization to obtain and evaluate the credit history, consumer credit reports, public records, and other credit-related information of the Client in connection with credit evaluation, underwriting, or other business purposes; and

WHEREAS, the Client is willing to provide written consent to permit the Requesting Party and its agents to obtain such information as described in this Consent Form and to use such information consistent with applicable law and the terms set forth herein; and

WHEREAS, the parties intend to document the scope, duration, and limitations of this authorization and the responsibilities of each party with respect to confidentiality and permissible use.

SCOPE OF AUTHORIZATION

The Client hereby authorizes the Requesting Party to obtain and review the following types of information for the purposes set forth in this Consent Form:

Specific authorizations (check all that apply):
Obtain consumer credit report(s) from consumer reporting agencies
Review public records (judgments, liens, bankruptcies)
Contact credit references and trade creditors

PAYMENT TERMS

The Client acknowledges that, to the extent applicable, the Requesting Party may charge a fee for obtaining credit reports or processing this authorization. Payment terms are set forth below.

TERM AND TERMINATION

This Consent is effective as of the Start Date and shall continue until the End Date, unless earlier revoked in writing as provided herein.

Start Date:   End Date:

CONFIDENTIALITY

The Requesting Party shall treat all information obtained pursuant to this Consent as Confidential Information. Such information shall be used solely for the Permitted Purpose described in this Consent and shall not be disclosed to third parties except (a) as required by law, (b) to its professional advisors who agree to maintain confidentiality, or (c) as otherwise expressly authorized in writing by the Client. The Requesting Party will take reasonable measures to protect against unauthorized disclosure.

AUTHORIZATION AND CERTIFICATIONS

By signing below the Client certifies under penalty of perjury that the information provided in this Consent Form is true and correct. The Client expressly authorizes the Requesting Party and its agents to obtain consumer credit reports, verify credit references, and to otherwise investigate the Client's credit history for the Permitted Purpose. The Client understands that a copy of this authorization may be accepted as an original.

The Client further acknowledges that any revocation of this consent must be made in writing, delivered to the Requesting Party at the address provided below, and that such revocation will not affect disclosures made prior to receipt of the revocation.

GOVERNING LAW

This Consent Form shall be governed by and construed in accordance with the laws of the State chosen by the Requesting Party below, without regard to conflict-of-law principles. Any dispute arising under or related to this Consent shall be subject to the exclusive jurisdiction of the state or federal courts located in the chosen jurisdiction.

ENTIRE AGREEMENT

This Consent Form, together with any written attachments executed by the parties, constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior and contemporaneous agreements, representations, and understandings, whether written or oral. No amendments shall be effective unless in writing and signed by both parties.

REQUESTING PARTY INFORMATION

ADDITIONAL PROVISIONS

The Client agrees to indemnify and hold harmless the Requesting Party and its agents from any liabilities, claims, losses, or expenses arising from the Client's misrepresentations or breach of this Consent, except to the extent caused by the gross negligence or willful misconduct of the Requesting Party.

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