10950 Linpage Place St. Louis, MO 63132 PH: 314-241-1214 FX: 314-241-2277 www.hy-c.com
AUTHORIZATION TO RELEASE BANK INFORMATION
By signing this Authorization, Applicant is agreeing to allow HY-C to solicit credit information for the purposes of determining the credit worthiness of A pplicant’s business in establishing open credit terms. By signing below, Applicant authorizes financial institution to release information concerning your account.
I, _______________________________________ (applicant name) of ____________________________ (company name),
hereby authorize ______________________________(credit institution) to release requested information
concerning my account and credit to the HY-C Company, Inc. of St. Louis, Missouri.
Account #:
Signed:
Printed Name:
Date:
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