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

Full Name(s)
Primary Phone Number
Secondary Phone Number

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____/____/______