Guarantor Authorization to Obtain Consumer Credit Report

OMB APPROVED NO. 0648-0012

Expires XX/XX/20XX

Guarantor Authorization to Obtain Consumer Credit Report and Conduct a
Credit Inquiry

I authorize the National Marine Fisheries Service, Fisheries Finance Program (FFP) to obtain a
credit report and conduct a credit investigation on ___________________. The FFP will use this
information to evaluate my offer to guarantee debt for
_________________________________.
This authorization is valid for purposes of verifying information given pursuant to any lawful
purpose covered by the Fair Credit Reporting Act.
Upon request, the FFP will provide me with the name and address of the Reporting Agency
contacted to supply the report. I understand that credit inquiries have the potential to impact
credit scores.

Signature: ____________________________________

Authorized Signer Name:____________________________________________________
Tax Identification Number:___________________________________________________
Date of Formation:_________________________________________________________
Mailing Address:__________________________________________________________
Previous Mailing Addresses (last seven years)___________________________________