I, the undersigned consumer, do hereby authorize JM Real Estate, Inc., by and through its independent
contractor, to procure a consumer report and/or investigative consumer report on me.
These above-mentioned reports may include, but are not limited to, employment and education
verifications; personal references; personal interviews; my personal credit history based on reports from
any credit bureau; my driving history, including any traffic citations; a social security number verification;
present and former address; criminal and civil history/records; and any other public record; and, any other
information bearing on my credit standing, credit capacity, creditworthiness, character, general reputation,
personal characteristics, trustworthiness, and/or mode of living.

I understand that the investigative consumer report I have authorized above may include information
obtained by interviews with my neighbors, friends and/or associates, and/or others with whom I am
acquainted or who may have knowledge concerning said information. I understand that I am entitled to a
complete and accurate disclosure of the nature and scope of any investigative consumer report prepared
on me upon my written request to the independent contractor performing this search that is made within a
reasonable time after the date hereof.

I further authorize any person, business entity or governmental agency who may have information relevant
to the above to disclose the same to JM Real Estate, Inc., by and through said independent contractor, and
any and all persons, business entities, and governmental agencies, whether public or private, from any and
all liability, claims and/or demands, of whatever kind to me, my heirs or others making such claim or
demand on my behalf, for procuring, selling, providing, brokering, and/or assisting with the compilation or
preparation of the consumer report and/or investigative consumer report hereby authorized.

Credit Application

Personal Information
Applicant Name*
Date of Birth*
Spouse Name (If Applicable)
Spouse Date of Birth
Current/Former Space
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