Dear ...

RE: Credit Reference - __(Name of Customer)__

Our customer, __(Name of Customer)__, has recently requested a credit account with our organization and has listed you as a credit reference.

As authorized by __(his/her/their)__ signature below, we would appreciate any information that you can provide to us on the credit history of __(Name of Customer)__ with your company. Please include the length of time __(he/she/they)__ __(has/have)__ had an account with you. We would also appreciate your comments on repayment patterns that have emerged on this account. All information you provide to us will, of course, remain highly confidential. We thank you in advance for responding to this request.

Yours truly,

The signature below hereby authorizes the release to __(Name of Organization)__,

any account credit history that__(Name of Organization)__ has on record for __(me/name of company)__.

__(Name of Customer)__

X____________________________ Date_______________

Authorized Customer’s Signature