This document is a credit report request form for an affordable housing program. It requests the applicant's name, current and previous addresses if at the current address for less than 3 years, social security number, driver's license number, date of birth, signature, and date. The request is signed by an associate president and approved by an assistant president.

1. CREDIT REPORT REQUEST
FOR AFFORDABLE HOUSING PROGRAM
APPLICANT : _______________________________
CURRENT ADDRESS: _______________________________
_______________________________
ADDRESS IF ABOVE
ADDRESS IS LESS
THAN THREE (3) YRS. _______________________________
_______________________________
SOCIAL SECURITY NO: _______________________________
DRIVER’S LICENSE NO: _______________________________
DATE OF BIRTH : _______________________________
________________________ _____________________
Applicant’s signature Date

2. Requested by: Approved by:
___________________ __________________________
Dawn Genco, Associate Gerard Velázquez, III,
President