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RELEASE AUTHORIZATION AND CERTIFICATION OF MILITARY STATUS:

I (Applicant) am applying for a loan with you (Gibson McDonald Furniture) under the provision of Section 552a(b) Public Law 93-579, commonly known as the Privacy Act., Dept of Defense 5400.1 1 enc 5, Par 302 apr 340 - 21 Dept of the Army, 27 August 1975 Section C, Par 24 AFR 12 - 35 Dept of the Air Force Par 7a(1), SECNAVINST 5211.5 Dept of the Navy 14 August 1975. I understand that the lender will not contact my Commanding Officer in connection with this debt unless I specifically give the Lender prior consent to make such contact. With full knowledge and understanding of this right, I hereby consent to contacting my Commanding Officer and/or Custodian of my official records to obtain my current military and/or civilian address even though I may be discharged and/or retired from military service. I also consent to you contacting my Commanding Officer in connection with the collection of the loan made hereby at any time when it is in default and until such time as the loan has been paid in full.

I give you permission to request a consumer credit report from consumer credit reporting agencies in considering this application and subsequently for the purpose of an update, renewal, or extension of credit; or for the purpose of reviewing or collecting my account. Upon my request you will inform me of the name and address of each consumer credit reporting agency from which you obtained a consumer report, if any, relating to this application.

California Residents: If I am married, I may apply for a separate account. After credit approval, each applicant shall have the right to use this account to the extent of any credit limit set by you and each applicant may be liable for all amounts of credit extended under this account to any joint applicant.

I hereby declare that all such statements and answers are correct and I hereby authorize you to verify any of the above information furnished therein.

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**Additional information may be required at time of sale**

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Gibson McDonald Furniture
395 Bonneyman Road
Blackshear, Georgia 31516
Phone: 912-490-1001
Email: bill@rjtbm.com