Release of Information Form

AUTHORIZATION FOR RELEASE OF INFORMATION

I consent, authorize and direct any Federal, State, local government agencies, associations, institutions, organizations, business or individuals to release to American Train Destination Lines/ATD LINES any information such as:

1. Files,
2. Records,
3. Reports,
4. Materials.

Held by your agency, institution, association, business, organization or individual needed for a complete background check, verify identity and fitness.

I understand and agree that this authorization or the information obtained with its use by ATD LINES. May be given to other Governmental Agencies, Law Enforcement, shared with association and organizations or any business involved with ATD LINES or administration of enforcement of programs and services, rules and policies.

INFORMATION COVERED

I, understand that depending on program policies and requirement, previous or current information my be used by ATD LINES and such verification or inquiries may be requested, including but are not limited to:

1. Identity and Marital Status,
2. Residence and Rental Activity,
3. Credit and Criminal History,
4. Medical or Child Care Allowances,
5. Employment, Income and Assets.

GROUP(S) OR INDIVIDUAL(S) WHO MAY BE ASKED

Groups or individuals that may be asked, include, bur not limited to:

1. Previous Landlords,
2. Courts and Post Offices,
3. Law Enforcement,
4. Support and Alimony Providers,
5. Credit Providers and Credit Bureaus,
6. State Unemployment Agencies,
7. Social Security Administration,
8. Utility Companies, Welfare Agencies,
9. Schools and Colleges,
10. Past and Present Employers,
11. Veterans Administration,
12. Medical Provider,
13. Child Care Providers,
14. Transportation and Transit,
15. Banks and Financial Institution.

COMPUTER MATCHING NOTICE AND CONSENT

I understand and agree that American Train Destination Lines/ATD LINES or any agency or entity involved with ATD LINES, may conduct computer matching programs to verify the information supplied. Information obtained may be shared in the course of ATD LINES Administration, subject to provisions of applicable civil rights laws and credit reporting requirements.

TERMS

I agree that photocopies of this authorization shall be effective, as an original and this authorization shall remain in effect until obligations, security deems. I agree to pay ATD LINES $5,000 or a specified amount for a search that is complete.

Signature: _____________________________ Printed Name: ___________________Date: ________
Residence Address: _________________________________________________________________
Residence Phone #: ______________________Email: ______________________________________
Employment Address: ________________________________________________________________
Employment Phone #: ____________________Email: _________________WWW: ________________