AUTHORIZATION TO SHARE INFORMATION

By signing below, I/we authorize and appoint Freedom Corporate Solutions Limited d.b.a. SerenityLoans (the “Loan Advisor”) as my agent and attorney-in-fact for the purposes of securing medical financing (a “Medical Loan”). Pursuant to this appointment I/we hereby empower and authorize the Loan Advisor to:

Directly and/or indirectly provide any and all financial or other information about me, including (but not limited to) information that is considered to be non-public personal information under Title V of the Gramm- Leach-Bliley Act of 1999 (15 U.S.C. § 6801 et seq.) and its implementing regulations, or any information otherwise treated as personal and confidential information under other applicable law (collectively, the “Personal Information”) to any bank, credit union, financial services company, or other lender (individually and collectively, the “Lender”) to whom either the Loan Advisor, on my/our behalf, or I may submit an application for a Medical Loan; and
Directly and/or indirectly receive Personal Information about me from the Lender.

By signing this authorization, I/we also agree to release and to indemnify, defend, and hold harmless the Lender from any responsibility or liability for any claims, demands, and/or damages (including reasonable attorneys’ fees and expenses) directly or indirectly related to or arising from the Loan Advisor providing or receiving Personal Information to or from the Lender. I/we understand that any dispute regarding the nature of the Personal Information provided and/or received by the Loan Advisor is solely between me/us and the Loan Advisor. I also understand and agree that the Lender may rely on this authorization, and shall gain the benefit of its protection and terms, until I/we inform such parties in writing that it is revoked.

IN WITNESS WHEREOF, I/we have hereunto electronically signed my/our name(s) this day 03/10/2010

Borrower 1
Type Name
Electronic Signature
By checking the above box, I hereby sign this Authorization
First Name
Last Name
DOB
Social Security Number
Street Address
City

State

Zipcode

Home Telephone
Work Telephone
Cellphone
Email Address

Borrower 2
Type Name
Electronic Signature
By checking the above box, I hereby sign this Authorization
First Name
Last Name
DOB
Social Security Number
Street Address
City

State

Zipcode

Home Telephone
Work Telephone
Cellphone
Email Address

Treatment Facility/State
Loan Amount
Repayment Period Months

By clicking Submit, I authorize Freedom Corporate Solutions Limited d.b.a. SerenityLoans (hereafter referred to as “SerenityLoans”) to check my credit references and to obtain and use consumer reports (i.e. credit reports) on my credit history in connection with my Loan Application and in connection with any update, renewal or extension of credit for which I have applied. If I request, I will I will be informed whether or not consumer reports are obtained, as well as the names and addresses of the consumer reporting agencies (i.e. credit bureaus) that furnish the reports. I further authorize SerenityLoans to provide information regarding the status of my transaction to the Facility identified above. I authorize that Facility to release to SerenityLoans, the lending institution, its agents, subsequent holder of the loan and its agents, any requested information pertinent to this Loan Application, including but not limited to, employment, enrollment status, prior loan history and my current address. I agree to refer to my Promissory Note for notices to California, Ohio and Wisconsin residents. Even if I have elected to opt out of information sharing or do so in the future, I understand and agree that this consent authorizes SerenityLoans to share my information for purposes of processing this Loan Application and servicing any resulting loan. I have completed this Loan Application to obtain credit and, by Clicking Submit, certify that the above statements are true and complete.