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Authorization for Release of Information

AUTHORIZATION FOR RELEASE OF INFORMATION – CONECTUS WIRELESS
EACH principal/owner owning 20% of Subagent’s company is required to complete this Authorization.

 

TO WHOM IT MAY CONCERN:

I,

am having a confidential background investigation and credit check of me performed by a security firm retained by ConectUS Wireless, in connection with prospective business undertakings. The investigation is being conducted by a security firm retained by ConectUS Wireless.

Therefore, I do hereby authorize a review and full disclosure of all records, or any part thereof, concerning myself or any business enterprise with which I am associated to a security firm retained by ConectUS Wireless, whether said records are public or private, and including those which may be deemed to be of a privileged or confidential nature.

The intention of this authorization is to provide information that will be utilized as investigative source material. The undersigned releases all persons, including but not limited to, a security firm retained by Verizon Wireless and its agents, and any person or firm which may have retained them to conduct this investigation, from any and all liability which may arise in connection with this investigation or the good faith disclosure of any information by or on behalf of the undersigned or by any individual or firm contacted in connection with this investigation.

Applicant Complete First, Middle, and Last Name

Title

Email

Social Security #

Date of Birth

Home Address

Drivers License #

Signature

Signature