DS9 Document EFTA00611172

NCO Financial Investigative Services BACKGROUND AUTHORIZATION FORM (Complete and Return to Lender to forward to NCO) NAME: HOME ADDRESS FOR THE PAST 10 YEARS: SOCIAL SECURITY NO: DATE OF BIRTH: PHONE NUMBER: DRIVERS LICENSE NUMBER: STATE: I hereby authorize inquiries by NCO Financial Systems, Inc., Financial Investigative Services into my business, personal, financial, and law enforcement background. This may include contact with credit reporting agencies, business associates, employers, educational institutions, state, federal or government agencies, regulatory agencies, or other institutions that can provide information relating to this investigation. I also hereby authorize any of the above named entities to furnish information, including copies of records / transcripts pertaining to the above matters. (Signature) (Date) EFTA00611172