CREDIT REPORT AUTHORIZATION AND RELEASE

As part of the telephone service application process, a credit check is necessary.  Please complete the following form that grants Carr Communications access to view your credit report for qualification purposes.  you may also obtain a once-a-year free credit report at www.annualcreditreport.com

Some conditions that may require a security deposit are:

• Inaccurate or unverifiable data on application
• History of payment default of utility service
• Outstanding telephone bills at service address with occupant still residing there
• Failure to provide or incomplete verifiable personal identification
• Refusal to complete and submit this form

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Social Security Number (required)

Date of Birth (required)

First Name (required)

Middle Name/Initial (required)

Last Name (required)

Street Address (required)

City (required)

State (required)

ZIP Code (required)

Previous Address (if applicable)

Email Address (required)

Authorization is hereby granted to Carr Communications/Carr Telephone Company to obtain a standard factual data credit report through a consumer credit reporting agency chosen by Company. [acceptance* credit-authorization]

Signature - entering my full name in this space serves as my legal signature on this document.