Credit Check Authorization Form

CREDIT CHECK AUTHORIZATION FORM

As Talquin Electric Cooperative, Inc. requires a credit check for waiving security deposits, the

undersigned consents and authorizes Talquin Electric Cooperative, Inc. to obtain a consumer

credit report on the undersigned for such purpose.

Name:

________________________________________________

Address:

________________________________________________

SSN:

________________________________________________

Applicant Signature: __________________________________________

Date: __________

For TECI use only:

Service Order #: ___________________________ Account #: ____________________

Form of ID Presented: _____________________________________________________

TECI Employee: ______________________________

MS Office Location:_________

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Parent category: Financial