MSI
Glen Road Plaza, Suite 221, West Lebanon, NH 03784
Phone (603) 298-8060 Fax (603) 298-6080
Visit our website at: www.msipi.com
Or email us at: info@msipi.com

CREDIT RELEASE AUTHORIZATION

In connection with my application for employment with your company, I hereby authorize MSI to furnish a consumer credit report regarding me.

The information from the credit report will not be used in violation of any Federal or State Equal Employment Opportunity Law or Regulation. You have the right to obtain a copy of the report and the right to dispute any information, contact MSI at (800) 639-8001.

I HEREBY AUTHORIZE, WITHOUT RESERVATION, ANY INFORMATION SERVICE BUREAU CONTACTED BY BACKGROUNDSPLUS.COM, TO FURNISH THE ABOVE-MENTIONED CREDIT INFORMATION.

Signature________________________________________________________ Date___________

(*box*) For residents of California, Minnesota and Oklahoma ONLY: Per state laws you are entitled to receive a copy of your consumer credit report directly from the credit bureau. If you wish to receive this report please check this box.

APPLICANT: Please provide us with the following (print clearly):

Full Name_______________________________________________________________________

Social Security Number____________________________________________________________

Street________________________________Apt.____City______________________State_____

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EMPLOYER REQUESTING CREDIT REPORT (please fill in)

Company Name:_________________________________ Account #:_______________________

Tel.____________________________________ Fax:____________________________________