CREDIT REPORT AUTHORIZATION FORM

Authorization is hereby granted to My Land Mortgage, to obtain a consumer credit report through a credit reporting agency chosen by My Land Mortgage. I understand and agree that My Land Mortgage 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 My Land Mortgage office for use only by My Land Mortgage staff. This information will not be disclosed to anyone by My Land Mortgage without my written consent.

Furthermore, I understand that, should I choose to apply for financing through My Land Mortgage, 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 My Land Mortgage 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 My Land Mortgage TO OBTAIN A COPY OF YOUR CREDIT REPORT.