Last Name___________________________	First Name___________________________
Home Address________________________	City/St/Zip____________________________
S.S.#________________________________	Date of Birth__________________________
Joint Spouse Report:
Last Name___________________________	First Name___________________________
Home Address________________________	City/St/Zip____________________________
S.S.#________________________________	Date of Birth__________________________

The Undersigned hereby consent(s) to _____________________________ use of a nonbusiness consumer credit report on the undersigned in order to further evaluate the credit worthiness of the undersigned as principal(s) proprietors) and orgaunterr(s) in connection with the extension of business credit as contemplated by this credit application. The uncersigned hereby authorize(s)_____________________________to utilize aconsumerr credit report on the undersigned from time to time in connection with the extension or continuation of the business credit represented by this credit application. The undersigned as (an) individual(s) hereby knowingly consent(s) to the use of such credit report consistent with the Federal Fair Credit Reporting Act as contained in 15 U.S.C.@1681 et seq.

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Signature	Signature
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Date