CREDIT REPORT AUTHORIZATION FORM

Authorization is hereby granted to West Penn Financial Service Center Inc., to obtain a consumer credit report through a credit reporting agency chosen by West Penn Financial Service Center Inc.. I understand and agree that West Penn Financial Service Center 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 West Penn Financial Service Center Inc. office for use only by West Penn Financial Service Center Inc. staff. This information will not be disclosed to anyone by West Penn Financial Service Center Inc. without my written consent.

Furthermore, I understand that, should I choose to apply for financing through West Penn Financial Service Center 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 West Penn Financial Service Center 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 West Penn Financial Service Center Inc. TO OBTAIN A COPY OF YOUR CREDIT REPORT.