®  The Complete Wholesale Line of  Terminals, Wire and Wiring Devices,  Nationwide Automotive - Truck - Marine - Farm - Industrial	Made in the U.S.A. 1620 32nd St. Springfield, OR 97478 (800) 547-4711 FAX (541) 744-1173 Phone (541) 744-0630

Bank Information Release Authorization

Due to the tightening of regulations regarding divulging credit information, banks are now requiring written authorization from their depositors for the release of any information associated to their account.

When you return your completed Credit Application, please sign this authorization for your bank and return it as well.

Thank You.

Company:	Name: __________________________________________________________________
	Street Address: ____________________________________ PO Box: ______________
	City: ______________________________ State: _______ Zip: _________________
	Phone: ____________________________ Fax: ____________________________

Bank:	Name: __________________________________________________________________
	Mailing Address: ___________________________________ PO Box: ______________
	City: ______________________________ State: _______ Zip: _________________
	Phone: ____________________________ Fax: ____________________________

Authorize:

I give my permission for the release of information regarding my accounts as required on the attached Bank Credit Information Request form. Signature: ___________________________ Date: ___/___/___ Title: ___________________________

Accounts:	Checking Acct #s:	__________________________	__________________________
		__________________________	__________________________
	Loan Acct #s:	__________________________	__________________________
		__________________________	__________________________