U.S. SMALL BUSINESS ADMINISTRATION
BORROWER’S CONSENT TO VERIFY INFORMATION
AND 3
RD
PARTY AUTHORIZATION
SBA LOAN NUMBER:
I hereby authorize the United States Small Business Administration (SBA) to verify my past and
present employment earnings and records, bank accounts, stock holdings and any other asset
balances that are needed by SBA in reference to the above stated SBA loan number. I further
authorize SBA to order a consumer credit report and verify other credit information, including past
and present mortgage and landlord references, as needed in connection with the above SBA loan.
It is acknowledged that an executed copy of this form will also serve as proper authorization and
consent.
The information obtained by SBA is to be used only in reference to the SBA loan number herein
stated.
Additionally, the U.S. Small Business Administration is hereby authorized to release any and all
information about my Loan to the third party(s) indicated below. I [We] understand that information
released by US Small Business Administration may include, but may not be limited to,
information relating to my loan amount and payment transactions history, and/or the provision of
copies of my loan documents, which may contain non-public information relating to all obligors and/or
guarantors (if applicable).
I [We] acknowledge that should I [We] wish to terminate this authorization, I [We] must contact
the U.S. Small Business Administration at 1-800-736-6048 and submit the request in writing to your
loan servicing center.
Name of Authorized Third Party(s):
Expiration Date of Third Party(s) Authorization:
Note: If you do not want to authorize the release of information to a Third party(s), please indicate
by typing “NONE” in the space provided: Doing so does not prevent SBA from
obtaining background and/or credit information needed.
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