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AUTHORIZATION AND RELEASE FOR THE PROCUREMENT OF A CONSUMER CREDIT REPORT

(In accordance with the Fair Credit Reporting Act)

I, the undersigned consumer, do hereby authorize Atlas Information Research, Inc., by and through it's contractors, to procure a consumer credit report concerning me.

I further authorize any person, business entity or governmental agency who may have information related to my credit report to disclose this information to Atlas Information Research, Inc., and it's agents, including but not limited to any and all credit reporting agencies, regardless of whether such person, business entity or governmental agency compiled the information itself or received it from others.

I hereby release Atlas Information Research, Inc., and it's contractors from any liability, claims, and/or demands of whatever kind, to me, my heirs or others making such claims or demands on my behalf, for procuring, selling, providing, or assisting with the compilation of the consumer report hereby authorized by me.

Name_______________________________________________________

Signature________________________________________ Date________________

Residence Address_____________________________________________

City_____________________ State_______ Zip_________

Social Security Number__________________________ DOB____________

Telephone Number_____________________________

    to the FCRA Purpose Page.