R09 LMB Credit Authorization

Page 1

CREDIT AUTHORIZATION To all reporting agencies and to all creditors, depositories, and landlords of the undersigned: Please be advised the undersigned have made application to First National Bank and Trust Company requesting an extension of credit. Therefore, the undersigned hereby authorizes you to make a consumer report and/or disclosure to First National Bank and Trust Company or any agent or employee thereof, of indebtedness, deposit balance, employment or rental history. A photographic or carbon copy of this authorization bearing a photographic or carbon copy of the signature(s) of the undersigned may be deemed to be equivalent of the original hereof and may be used as a duplicate original.

BY:

Date: Applicant

BY:

Date: Applicant

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