In connection with my credit application submitted to Money for Matrimony, LLC, a Michigan limited liability company, and/or any of its affiliates, subsidiaries or divisions ("Matrimony Financial") or in connection with my loan contract assigned to Money for Matrimony, LLC, the undersigned (hereinafter referred to as "I") hereby consents and authorizes any person, entity, current employer, prior employer, and all others to release and/or disclose to Money for Matrimony any and all personal information, nonpublic personal information as that term is defined in the Gramm-Leach-Bliley Act, Title V, and applicable regulations thereto ("GLB Act"), employment information and/or credit information (hereinafter referred to as "Information") concerning the undersigned. I hereby release any such person, entity, current employer, prior employer, and all others from any and all liability that may result in furnishing the Information. I also release Money for Matrimony and any person, entity, current employer, prior employer, and all others from any obligation to provide the undersigned with written notification of such release and/or disclosure of such Information. I also consent to and authorize Money for Matrimony's use of original or copies of this executed form as valid consent and authorization. My selecting the "I Agree" option below certifies that I have read, that I understand, and that I have voluntarily executed this form. IN ADDITION, THERE IS A NON-REFUNDABLE APPLICATION FEE FOR ANY REASON IN THE AMOUNT OF $50.00 (FIFTY DOLLARS).

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Money for Matrimony
P.O. Box 20253
Ferndale, MI 48220
(Office) 248.336.9292
(Fax) 248.336.9315
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