DISCLOSURE AND AUTHORIZATION
PERTAINING TO CONSUMER REPORTS
PURSUANT TO THE FAIR CREDIT REPORTING ACT

This is a release providing LeavenLaw written instructions to obtain one or more consumer/credit reports about you under the Fair Credit Reporting Act (“FCRA”) (15 U.S.C. §§1681 et seq.) in connection with your request for LeavenLaw’s legal assistance which necessarily includes obtaining, reviewing, and/or using your consumer/credit report for potential debt settlement, potential bankruptcy filing, as well as for assessing its overall completeness and accuracy. One or more reports about you may be obtained by LeavenLaw for such potential legal representation. You understand, however, that LeavenLaw may only share with you its counsel regarding the reports and may not distribute to you or any third party any consumer/credit report that it obtains as a subscriber.

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* I hereby have fully read this disclosure and authorization and, by providing my information herein and hitting ‘submit’ below, I authorize LeavenLaw to obtain such report(s) from any consumer/credit reporting agency for review and potential future legal representation. My submission of personal information herein is intended to qualify as “written” authorization, provided to LeavenLaw electronically, sufficient under The Electronic Signatures in Global and National Commerce Act (“ESIGN”) (15 U.S.C. §§7001 et seq.) as my signature. Electronic copies of this written authorization that show my signature are as valid as the original signed by me.

* REQUIRED FIELDS

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