Forms \ Credit Report Authorization Form

I hereby authorize, Debt Counseling Corp. to obtain my credit profile. I understand that although I may ask Debt Counseling Corporation questions pertaining to my credit report, Debt Counseling Corp. is not able to furnish me with a copy of my credit profile.

Debt Counseling Corporation has explained that my credit profile is being requested for the sole purpose of providing credit counseling and financial management assistance and will not be used for the purpose of granting credit. Debt Counseling Corporation does not report information to any credit reporting agency. It is the sole responsibility of the creditors participating in my Debt Management Program to update credit reporting agencies, when applicable, in accordance with the Fair Credit Reporting Act (FCRA).

By providing the following information electronically you are giving Debt Counseling Corporation authorization to obtain your credit report.

* required field
Name *
Address *
City *
State *
Zip *
Phone *
Social Security *	(please enter first 4 digits)
Date of Birth
E-Signature	(please type full name here)

Name of Spouse/Co-Applicant
Address
City
State
Zip
Phone
Social Security	(please enter first 4 digits)
Date of Birth

E-Signature	(please type full name here)

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