Date_________

CONSUMER AUTHORIZATION FORM

Able Screening offers all three nationwide credit reports. The cost of the first credit bureau report is $20, $10 for the second, and $10 for the third, per INDIVIDUAL.

(A SEPARATE AUTHORIZATION FORM IS REQUIRED FOR EACH CONSUMER)

Indicate which credit report/s you are requesting:

EXPERIAN ___X___ EQUIFAX ______ TRANS UNION______

Indicate how you will be paying: CASH ______ CHECK ______ CREDIT CARD _________

How did you hear about Able Screening Services? __________________________

I hereby authorize Able Screening Services to furnish me a copy of my credit report. I understand that Able Screening Services has no control over the contents of the report issued by the authorized bureau. Any dispute must be handled directly with the reporting creditor or agency.

PLEASE PRINT CLEARLY

NAME LAST : __________________  FIRST: ____________________   MID : _________

ADDRESS : __________________    CITY : ____________________    STATE : _______

ZIP :  ___________        TELEPHONE # :  _______________  FAX # _______________

SOCIAL SECURITY #: ________________DATE OF BIRTH  :      _________________

DRIVER’S LICENSE OR ID # : ______________________  EXPIRATION : _________

SIGNATURE: ________________________________      

ALL AUTHORIZATIONS MUST BE SIGNED

                 Phone: 415-353-0744               Fax: 415-353-0760

For AbleScreening Use only

Consumer ID/ drivers license # :__________________  exp . ______

Verified by: ___________________ date : _____________________