Primary Applicant

Personal

Address

Employment

Income

You understand that by clicking on the I AGREE button immediately following this notice, you are providing 'written instructions' to HGreg Lux under the Fair Credit Reporting Act authorizing HGreg Lux to obtain your personal consumer report from one or more credit reporting agencies. You authorize HGreg Lux to obtain such information solely to conduct a prequalification for credit.

I have read the , agree with the consent statement above, and authorize you to contact me via phone, text and/or email.