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CREDIT REPORT AUTHORIZATION <br />201i091�ti <br />I Kenneth L. Layher <br />5212 S Burwick Hd <br />Wood River, NE 68883 <br />� <br />Business Entity <br />°f ` T �"" .' Date 12•01-2011 <br />Tax ID # <br />Customer # 3300814 <br />Other Services <br />� <br />� <br />Savings Account # <br />Checking Account # <br />Loan # 3300814 <br />As used in this document, the words "you" and "your" mean the individual signers listed below and the words "we" and "us" <br />mean the financial institution. <br />We need to verify your creditworthiness for the following reason(s�: <br />� The above-named Business Entity with which you are associated has applied for a loan from us. <br />❑ The above-named Business Entity with which you are associated has applied to open a deposit or share account with us. <br />❑ <br />You understand that we have a current need to review your creditworthiness as an individual. By signing below, you authorize us <br />to check your credit account and employment history and/or have a credit reporting agency prepare a credit report on you. You <br />also acknowledge that we will verify the creditworthiness of the above-named Business Entity. <br />Kenneth L. er e et L. La er <br />(Neme/Title) (Id ntifying Information) (Neme/Title) (ldentifying Informetion) <br />� /� <br />(Sign tu 1 (Date) (Signature) IDate) <br />(Name/Title) <br />(ldentifying Information) (Name/Title) (ldentifying Information) <br />ISignature) IDate) (Signaturel <br />IDate► <br />er • �02000 Bankars Systems, Inc., St. Cloud, MN Form FCRA-CRA-B 11/20/2000 lp�ge 1 of 9J <br />