CREDIT REFERENCE DISCLOSURE AGREEMENT
The following information is provided in order to obtain a credit reference from Interstate Billing Service, Inc. on behalf of our mutual customer. I/We hereby certify that the named customer has authorized us to request this information from Interstate Billing Service, Inc., or its representatives, on their behalf.

I/We agree to conduct transactions with Interstate Billing Service, Inc., its successors, assigns, and/or designees, by electronic means, including as appropriate through use and receipt of electronic records and electronic signatures, as required by Interstate Billing Service, Inc., its successors, assigns, and/or designees.