CREDIT APPLICATION

        Authorization is given for the release to Mobile Home Remedies, LLC and/or assignees of any or all requested information related to my/our application for credit.  The current information will be requested for use in connection with a bona fide “permissible purpose” as defined in the Fair Credit Reporting Act, for the fee of $35 per applicant.

     Name________________________________

     Address______________________________

     SS#_________________ DOB____________

     Have you ever been convicted of a felony?_________

        Signature____________________________________ Date____________________