Release of Information Authorization – KNICKERBOCKER TENANT LEASE APPLICATION

Release of Information Authorization - KNICKERBOCKER TENANT LEASE APPLICATION

Release of information authorization

I hereby authorize any individual, company or institution to Release to tenant data verification and/or its representative any And all information that they have concerning my character, Reputation, mode of living, employment history, educational History, criminal activity and credit report

I hereby release the individual, company or institution and all Individuals connected therewith from all liability for any damage Whatsoever incurred in furnishing such information.

Tenant

Full Name

Date of Birth

Signature

Clear

SS#

Date

Co-Tenant

Full Name

Date of Birth

Signature

Clear

SS#

Date

Payment

Name of credit card holder

Signature of card holder

Clear

TENANT DATA VERIFICATION CO. INC.
SERVICING THE REALTY INDUSTRY
344 PORTION ROAD
LAKE RONKONKOMA, NEW YORK 11779
TEL.# (631) 615-2415 FAX# (631) 615-2422

I HEREBY AUTHORIZE TENANT DATA VERIFICATION, CO., INC., TO CHARGE MY CREDIT CARD FOR THE PURPOSE OF OBTAINING A CREDIT BACKGROUND. I (WE) RELEASE T.D.V. FROM ANY AND ALL LIABILITY FROM DOING SO.

Name of Credit Card Holder

Billling of Credit Card Holder

City

State

Zip Code

Credit Card Number

Expiration Date

Indicate type of card

Security Code

Signature of Card Holder

Clear

Please provide documentation for each item listed

Name

Address

Assets

Total of cash in banks, CMA's, CD's, etc. (see Schedule A)

Securities (see Schedule B)

Real Estate (see Schedule C)

Pension Funds (see Schedule D)

Life Insurance Cash Surrendered Value (see Schedule E)

Other Assets (see Schedule F)

Liabilities

Mortgage Payable (see Schedule C)

Other Liabilities (see Schedule G)

Total Liabilities

Net Worth

Income

Salary

Dividends & Interest

Other (see Schedule H)

Total Income

Signature Applicant

Clear

Date

Signature Co-Applicant

Clear

Date

A. Bank Information

Name, Address

Type of Account

Cash Balance

Name, Address

Type of Account

Cash Balance

Name, Address

Type of Account

Cash Balance

B. Securities

Description of Security

No. of Shares

Market Value

Description of Security

No. of Shares

Market Value

Description of Security

No. of Shares

Market Value

C. Real Estate

Location of Property

Market Value

Current Amt of Mortgage

Location of Property

Market Value

Current Amt of Mortgage

Location of Property

Market Value

Current Amt of Mortgage

D. Pension Funds

E. Life Insurance

Beneficiary, Insurance Co.

Cash Surrender Value

Beneficiary, Insurance Co.

Cash Surrender Value

Beneficiary, Insurance Co.

Cash Surrender Value

F. Other Assets

Description

Amount

Description

Amount

Description

Amount

G. Other Liabilities (other than Mortgages)

Description

Amount

Description

Amount

Description

Amount

G. Other Income

Source Of Income

Amount per Annum

Source Of Income

Amount per Annum

Source Of Income

Amount per Annum

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Release of Information Authorization – KNICKERBOCKER TENANT LEASE APPLICATION

Release of Information Authorization - KNICKERBOCKER TENANT LEASE APPLICATION

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