ENTERLINK TECHNOLOGY CREDIT REQUEST FORM 1.0 P.O. BOX 269 SAN BERNARDINO, CA 92402-0269 (800) 659-6516 VOICE "SYSOP PLEASE CALL AND GET CURRENT FAX NUMBER TO PLACE HERE" I give EnterLink Technology, Inc. and "PUT YOUR BBS NAME HERE" permission to run credit report(s) on ^_______________________________________. I understand that the credit report that I receive is to be used for legal purposes and that I will not add, change, delete any of the information on my credit report. First Name:_____________________________ Last Name:_________________________ Middle Intial:______ Birth Date:_____/_____/____ SSN:______-______-________ Street Address:______________________________________________ Apt:__________ City:__________________________________ State:_____________ Zip:__________ Home Phone:____________________________ Work Phone:________________________ Previous Address if less than 2 years from above address Street Address:______________________________________________ Apt:__________ City:__________________________________ State:_____________ Zip:__________ Occupation:____________________________ State ID Or Driver License Picture Here __________________________________________ | | | | | | | | | | | | | | | | | | | | | | | | ----------------------------------------- By signing below you swear under the law of purgery that all information is above is correct. ____________________________________________ ______________________ Sign Date PAYMENT TYPE: VISA ( ) MASTERCARD ( ) COD ADD $5. FOR SHIPPING ( ) NAME AS IT APPEARS ON CARD:___________________________________________________ MASTER CARD:__________________________________________________________________ EXP. DATE:______________ ID#:"SYSOP PLEASE PLACE THE ID# THAT ENTERLINK GIVES YOU HERE" DO NOT SIGN OR TYPE BELOW OF THIS LINE. ------------------------------------------------------------------------------- DATE RECEIVED REQUEST:_________/__________/____________ REPORT GENERATED BY:___________________________________ BBS ID#:"PUT YOUR ID NUMBER HERE"