Tenant Data Verification CO.INC.

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.

Applicants payment of $20 per applicant is non-refundable.

Apartment

Building

Name of credit card holder

Billing address of card holder

City

State

Zip Code

Credit card number

Expiration date

Indicate type of card

* 3 or 4 Digit Security Code

Signature of card holder

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Tenant Data Verification CO.INC.

Tenant Data Verification CO. INC.

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