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Cal
U-Rent Internet
Bank Disclosure Authorization |
By my signature below, I hereby authorize___________________________ to release information on the following accounts to Cal U-Rent for the purpose of establishing credit. Name of Credit Applicant (Company):______________________________ Savings Account #:____________________________________________ Checking Account #:___________________________________________ Name of Company Officer:_______________________________________ Officer's Signature:____________________________________________ Name of Banking Institution:_____________________________________ Address:_____________________________________________________ ____________________________________________________________ Tel. #: (
)___________________ FAX #: ( )_______________________ Acct. #:___________________ Opened:_________Avg. Balance:________ Acct.#: ___________________ Opened:_________Avg. Balance:________ Name of Banking Representative:___________________________________ Contact Telephone Number: ( )____________________________________ Date:_____________ Signature:___________________________________ Form Revised
June 2003 |