Marion A. Olson, Jr., Chapter 13 Trustee
1020 NE Loop 410, Suite 800
San Antonio, TX 78209

Debtor Education/Credit Rehabilitation Program

Phone: (210) 824-1460 x 164 							            Fax: (210) 824-1328

CONSUMER QUESTIONNAIRE & AUTHORIZATION

Name _____________________________________________________ Case # _________________

Address___________________________________________________________________________

City ________________________________ State______ Zip _________ Phone________________

Employer (his) _____________________________________________ How long? ______________

Employer (hers)_____________________________________________ How long? ______________

Bank/Credit Union used _____________________________________________________________

Type of account (checking, savings, etc.) ______________________________________________________

Type of credit desired? ____________________________________________________________________

Have you been denied credit? If so, by whom? ________________________________________________

________________________________________________________________________________________

Have you established any new credit? If so, name the creditor and the amount. ____________________

________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

I authorize the employees of Marion A. Olson, Jr., Chapter 13 Trustee, to assist with corrections to my credit files and to share information about my Chapter 13 bankruptcy as necessary with creditors and credit reporting agencies for the purpose of rebuilding my creditworthiness. I further authorize the office of the Chapter 13 Trustee to use any of the information in their files to compile statistical data for the credit rehabilitation program and to contact creditors regarding my account status.

Signed: ____________________________________________________________     Date:_________________

Signed: ____________________________________________________________     Date:_________________