Dear

Enclosed is a photocopy of Mr. Smith's signed authorization
for disclosure of credit information.  Would you be kind
enough to supply the information requested below.  We have
provided you with a copy of this request for your files.
Please return the original in the enclosed, postage paid
envelope.

     Name of Applicant:  __________________________________
     Address:            __________________________________
     City, State, Zip:   __________________________________


     Length of time of Credit Account:

     Highest Credit Extended:

     Credit Limit:

     Average Monthly Balance:

     Balance Now Due:

     Balance Past Due:

     Normal Paying Habits:

     Remarks: