TU CONSULTOR DE CREDITO

Aplicación para llenar es importante que escriba claro y en letra de molde este documento debe ser impreso y enviado a MCOPR a la dirección Cd-21 Calle Higuerillo Rio Hondo III Bayamón ,Puerto Rico 00961 antes de enviarlo debe comunicarse a uno de nuestros representantes autorizados para informaciones adicionales requeridas.

Máster Credit of Puerto Rico

Datos para crédito

APPLICANT FORM

** To be completed by individual or business whose credit is to be reported **

Master Credit Of Puerto Rico

CD-21 Calle Higuerillo Rio Hondo III Bayamon,Puerto Rico 00961
Phone: (787)448-4075 FAX (787)740-1915

APPLICANT Incomplete form may result in the decline of your application.

Please Type or Print Clearly

First Name __________________ Middle Initial_______ Last Name ____________________ Jr., Sr., I, II, III (Circle if applies)

Social Security No.___________________ Driver Lic.No./State ___________________Date of Birth
(mm/dd/yy)________________Current Street Address_________________________________ City____________________ State ________ Zip ___________Move In Date__________Move Out Date__________Current Landlord/Mgr_________________________TheirPhone_______________Rent $ _________________________________Home Phone ( ) ______________ Work Phone ( ) ______________ Income $ _____________ o Week o Month o Year Previous Street Address ________________________________ City____________________ State________ Zip ___________ Move In Date__________MoveOutDate__________CurrentLandlord/Mgr________________________ Their Phone_______________Rent $ _________________________________Current Employer & Address ____________________________________ Phone ( ) __________
Occupation _______________Hired Date__________ Termination Date____________ Monthly Salary $________________Previous Employer & Address ___________________________________ Phone ( ) __________ Occupation _______________Hired Date__________ Termination Date____________ Monthly Salary $________________I, _______________________________________ , give my authorization to__________________________________________

(Signature) (Company Name or Landlord Name)

and Master Credit Of Puerto Rico, L.L.C. to verify all of the above information, obtain a credit report, criminal history report and
verify employment information (including salary) on myself for one of the purposes checked below and I further agree to the terms

stated below.

� Credit Report � Credit Report W/Score � Partial Tenant Screen � Full Tenant Screen � Other (specify) __________________

Applicant: Please read before signing above. Application will not be processed without signature.: Applicant agrees to release and

indemnify Master Credit Of Puerto Rico L.L.C. (C.S.S.), as well as C.S.S.’s owners , employees and C.S.S.’s clients (Company or Landlord specified above) from
all liability arising from (1) C.S.S.’s access to or disclosure of information under this application, (2) Applicant uses or reliance on consumer credit information, and (3)
any other violations of the FCRA or other applicable laws due to the acts or omissions of C.S.S. or C.S.S.’s clients (Company or Landlord specified above). Further,
Applicant agrees to release and indemnify C.S.S.’s information suppliers, their parent, sister, and affiliate entities, as well as their officers, employees, contractors, and
agents from all liability arising from C.S.S.’s client’s (Company or Landlord specified above) unauthorized access, improper use, or reliance on consumer credit

information provided by C.S.S. pursuant to this agreement.