CREDIT REPORT AUTHORIZATION FORM

Authorization is hereby granted to Life Capital Lending Group, Inc., to obtain a consumer credit report through a credit reporting agency chosen by Life Capital Lending Group, Inc.. I understand and agree that Life Capital Lending Group, Inc. intends to use the consumer credit report for the purposes of evaluating my financial readiness to obtain a loan.

I understand that this credit report will be retained on file at the Life Capital Lending Group, Inc. office for use only by Life Capital Lending Group, Inc. staff. This information will not be disclosed to anyone by Life Capital Lending Group, Inc. without my written consent.

Furthermore, I understand that, should I choose to apply for financing through Life Capital Lending Group, Inc., a revised credit report costing an additional fee may be required.

My signature below authorizes the release to the credit reporting agency of financial information which I have supplied to Life Capital Lending Group, Inc. in connection with such an evaluation. Authorization is further granted to the credit reporting agency to use photostatic reproduction of this form if required to obtain any information necessary to complete my consumer credit report.

CHECKING THE BOX BELOW GRANTS PERMISSION FOR THE RELEASE OF FINANCIAL INFORMATION TO THE CREDIT REPORTING AGENCY AND GRANTS PERMISSION FOR Life Capital Lending Group, Inc. TO OBTAIN A COPY OF YOUR CREDIT REPORT.