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Credit Report Authorization and Privacy Disclosure Form
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I hereby authorize and instruct Dominion Financial Management, Inc. (hereinafter “DFM, Inc.”) to obtain and review my credit report. My credit report will be obtained from a credit reporting agency chosen by DFM, Inc. I understand and agree that DFM, Inc. intends to use the credit report for the purpose of evaluating my financial readiness to purchase a home and/or to engage in post-purchase counseling activities. My signature below also authorizes the release to credit reporting agencies of financial or other information that I have supplied to DFM, Inc. in connection with such evaluation. Authorization is further granted to the credit reporting agency to use a copy of this form to obtain any information the credit reporting agency deems necessary to complete my credit report. In addition, in connection with determining my ability to obtain a loan, I
Do Not Authorize
DFM, Inc. to share with potential mortgage lenders and/or counseling agencies my credit report and any information that I have provided, including any computations and assess¬ments that have been produced based upon such information. These lenders may con¬tact me to discuss loans for which I may be eligible, and these counseling agencies may contact me to discuss counseling services. I understand that I may revoke my consent to these disclosures by notifying DFM, Inc. in writing.
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Co-Applicant Social Security Number