C.A.C.H.E. INC.
63-65 SOUTH MAIN STREET
LIBERTY, N.Y. 12754
TELE: (845) 292-5821
FAX: (845) 292-0724
 
RELEASE OF INFORMATION
 
I, HEREBY AGREE AND GRANT PERMISSION TO COMMUNITY ACTION COMMISSION TO HELP THE ECONOMY, INC. (CACHE, INC.), TO SECURE AND REVIEW MY MOTOR VEHICLE RECORD, I HEREBY UNDERSTAND THAT THIS REVIEW IS FOR INSURANCE UNDERWRITING PURPOSES ONLY.
     
DRIVER'S LICENSE#:
DATE OF BIRTH:
 
SIGNED:
 
WITNESS:
 
DATE:
 
 
 
Note: You are not able to submit these forms, Forms are not programmed to do so, however you are able to print and send to C.A.C.H.E or bring them with you filled out so when you visit us, everything will be processed faster and more efficiently.
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