Home Improvement Inquiry

    Please note that our services are only available within the state of Mississippi and this program is not available for mobile homes.

    Property Information

    ​Authorization and Consent & Release, Nonpublic Personal Information Agreement

    ​​I (Applicant/Owner/Occupant) do hereby consent to and authorize Renaissance Community Loan Fund (RCLF), its partners, affiliates, agents, contractors and their respective assigns as part of my application for the Program, to request, access, review, disclose, release and share any and all Nonpublic Personal Information ("NPI"), whether provided by me in this application or by additional outside third parties with whom I may or may not have a relationship, as necessary for final determination of my eligibility for and the amount of assistance under the Program. I understand and acknowledge that any party disclosing information to the RCLF on my behalf is not responsible for any negligent misrepresentation or omission, and I agree to hold any such disclosing party harmless from and against all claims, actions, suits or other proceedings, and any and all losses, judgments, damages, expenses or other costs (including reasonable counsel fees and disbursements), arising from or in any way relating to their disclosure.
    As part of this consent, I further authorize RCLF, and any other financial institution, lender, insurer, other government agency (federal or state), credit bureau through a FCRA consumer report, financial service provider or any other third party to obtain, use and disclose any of my NPI in their possession, as necessary, to enable RCLF to administer the Program and to enable RCLF to process my application.
    I understand and acknowledge that RCLF may obtain, use and disclose any NPI received in its investigation of my application with third parties, including those referenced above, as necessary for final determination of my eligibility for and the amount of assistance under the Program.
    I acknowledge that I have received and reviewed RCLF's privacy policies as they relate to my NPI and my right to privacy associated therewith. I also understand and acknowledge that, as part of those policies, my consent may be revoked at any time with written notice to, as applicable, RCLF, I further understand and acknowledge that any such revocation of this consent may affect my ability to receive assistance under the Program.
    By completing and signing this application, I acknowledge and agree to the above and agree that this consent may be furnished on my behalf to any financial institution, lender, insurer, government agency (federal or state), credit bureau, financial service provider or other third party.

    Survey