Hickman & Associates
Post Office Box 21, Guthrie, Oklahoma 73044
(405) 229-4635 Fax (405)282-1329

RELEASE AUTHORIZATION CONSENT FORM

I hereby authorize Hickman & Associates, its subsidiaries, affiliates, employees or agents to conduct an inquiry and request and authorize all information from creditors, credit bureaus and credit reporting agencies be released to Hickman & Associates. I further authorize the above sources to release all information including salary data and subjective evaluations. I hereby release and hold harmles Hickman & Associates its subsidiaries, affiliates, employees, agents and all of the above sources from any and all liability for doing so and complying with this authorization.

Applicant’s Signature X___________________________________________________



Full Legal Name of applicant (please print) _________________________________________

Alias/Maiden: _____________________________________________________________

Social Security No. _____-_____-_____ Date of Birth _____/_____/_____

Current Address: ____________________________________________________________

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