US Financial Group
3520 Patrick Street, Suite 216, Lake Charles, LA 70605
Phone: 337-474-2352    Fax: 337-478-3697


My/Our application was given for the purpose of obtaining credit.

I understand and agree that US Financial Group may assign or transfer this credit application and may also communicate the information contained here in to others while deciding whether or not to extend credit.

I hereby certify, under the penalty of law, that the information that is contained in my/our application is a true and complete statement of my/our actual financial condition. In the event of any material change in my/our financial condition, I will immediately notify US Financial Group in writing.

I authorize all banks and business references, as well as any of my/our lessors, landlords and any other past or present creditors to give any and all necessary information to US Financial Group and to their assignees or transferees, which will assist US Financial Group in my/our credit inquiry.

The undersigned individual, recognizes that their individual credit history may be a factor in the evaluation of the credit application.

I hereby consent to and authorize US Financial Group and any assignee, lender or funding service that may be utilized to obtain and use a consumer credit report on the undersigned individual(s), now and from time to time, as may be needed in the credit evaluation and review process.

I waive any right or claim I/we would otherwise have under the Fair Credit Reporting act in the absence of this continuing consent.

Date: __________________________

Principal/Owner's Name (Print): _________________________________________

Principal/Owner's Signature:    _________________________________________