CREDIT REPORT AUTHORIZATION FORM

Authorization is hereby granted to People's Bank & Trust Company of Hazard Kentucky, to obtain a consumer credit report through a credit reporting agency chosen by People's Bank & Trust Company of Hazard Kentucky. I understand and agree that People's Bank & Trust Company of Hazard Kentucky intends to use the consumer credit report for the purposes of a mortgage loan application.

I understand that this credit report will be retained on file at the People's Bank & Trust Company of Hazard Kentucky office for use only by People's Bank & Trust Company of Hazard Kentucky staff. This information will not be disclosed to anyone by People's Bank & Trust Company of Hazard Kentucky without my written consent.

Furthermore, I understand that, should I choose to apply for financing through People's Bank & Trust Company of Hazard Kentucky, 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 People's Bank & Trust Company of Hazard Kentucky 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 People's Bank & Trust Company of Hazard Kentucky TO OBTAIN A COPY OF YOUR CREDIT REPORT.

In accordance with the USA Patriot Act, Federal law requires all financial institutions to obtain, verify, and record information that identifies each individual or entity opening an account. This includes all personal and commercial accounts, including loan and deposit accounts, as well as trust, brokerage, and investment accounts. When you open an account, you will be asked for your name, address, social security or tax identification number, date of birth (if applicable) and other information to allow People's Bank & Trust Company of Hazard Kentucky to identify you. You will also be asked to furnish your driver's license or other identifying documents during the loan process. We are required to follow this procedure each time you open an account, even if you are a current customer.