Date: 

 TO:     Credit Bureau Services, Inc.           Fax: 954-567-1441 OR Email to:  info@credit1400.com

 I am a realtor associate approved by and through United Realty Group, Inc..  United Realty Group, Inc. is not responsible for my charges.  I personally guarantee payment of all fees and charges owed Credit Bureau Services, Inc. and you have my permission to pull my credit report. This is for tenant screening purposes ONLY.  I will not pull credit reports for any other purpose.

  Name: _________________________________________________________

  Street: _________________________________________________________

  City, State & Zip :  ________________________________________________

  Home Telephone: ________________________________________________

  Office Telephone:   ________________________________________________

  Cell Phone: _____________________________________________________

  Fax: __________________________________________________________

  Social Security No:  ______________________________________________

  Business Email: __________________________ Personal Email:___________________________  

 

  X

Signature and Date  

Please fax this form to 954-567-1441 OR email to:  info@credit1400.com along with a copy of your driver's license or other acceptable form of photo ID and the credit card authorization form.  If you do not provide an ID, your application will not be processed.  All agents are set up for credit card payment ONLY.

Thank you!  We appreciate your business!

3503 N. Dixie Hwy, Oakland Park, FL  33334

954-561-1400            FAX:  954-567-1441

EMAIL:  INFO@CREDIT1400.COM