CREDIT REPORT ORDER
Please fill out the form, print and sign it, and mail it to:
Valley Mortgage Company Inc.
750 Union Street - Hudson, NY 12534
or 
fax the form to: (518) 828-0459

Full Name(s)
Current Address
City
State
Zip
Prior Address
(if less than 2 years at current address)
City
State
Zip
Social Security Number(s)

THE UNDERSIGNED AUTHORIZES VALLEY MORTGAGE COMPANY TO SECURE A CREDIT REPORT FROM AN AVAILABLE CREDIT BUREAU UTILIZED BY THE COMPANY.

Borrower_______________________________  Date____/____/______

Borrower_______________________________  Date____/____/______