CREDIT REPORT AUTHORIZATION FORM

Authorization is hereby granted to Urban Country Mortgage LLC, to obtain a consumer credit report through a credit reporting agency chosen by Urban Country Mortgage LLC. I understand and agree that Urban Country Mortgage LLC intends to use the consumer credit report for the purposes of evaluating my financial readiness to obtain a loan.

I understand that this credit report will be retained on file at the Urban Country Mortgage LLC office for use only by Urban Country Mortgage LLC staff. This information will not be disclosed to anyone by Urban Country Mortgage LLC without my written consent.

Furthermore, I understand that, should I choose to apply for financing through Urban Country Mortgage LLC, a revised credit report costing an additional fee may be required.

My signature below authorizes the release to the credit reporting agency of financial information which I have supplied to Urban Country Mortgage LLC in connection with such an evaluation. Authorization is further granted to the credit reporting agency to use photostatic reproduction of this form if required to obtain any information necessary to complete my consumer credit report.

CHECKING THE BOX BELOW GRANTS PERMISSION FOR THE RELEASE OF FINANCIAL INFORMATION TO THE CREDIT REPORTING AGENCY AND GRANTS PERMISSION FOR Urban Country Mortgage LLC TO OBTAIN A COPY OF YOUR CREDIT REPORT.