Credit Information Request Template

From (Requester):
Name/Company: __________________________
Address: __________________________
Email: __________________________
Phone: __________________________

To (Respondent):
Name/Company: __________________________
Address: __________________________
Email: __________________________
Phone: __________________________

1. Subject of Request

This request concerns the following individual or business:

• Name/Business Name: __________________________

• Address: __________________________

• Identification Number/Tax ID: __________________________

2. Purpose of Request

The information is being requested for the following purpose:
☐ Evaluation of creditworthiness for a new account or loan
☐ Vendor or supplier verification
☐ Lease or rental application
☐ Other: __________________________

3. Specific Credit Information Requested

Please provide the following details, if available:

• Current credit balance and limits

• Payment history and record of late payments

• Outstanding debts or obligations

• Any default or collection actions taken

• Other relevant financial information: __________________________

4. Authorization and Consent

I, the undersigned, hereby authorize the release of my/our credit information to the requester named above for the purpose stated herein.

Authorized Individual/Business Representative: __________________________
Signature: __________________________
Date: __________________________

5. Confidentiality Statement

All information provided shall be treated as confidential and used solely for the stated purpose in compliance with applicable privacy and data protection laws.

6. Contact for Questions

For questions or additional details, please contact:
Name: __________________________
Email: __________________________
Phone: __________________________