Authorization to Release Information
Dated: _____________
To: ______________________________________________
Borrowers: ______________________________________
Property: ________________________________________
Loan Number: ___________________________________
We, the undersigned, hereby authorize you to release information regarding the above-referenced loan to_________________________ and/or their agents or assignees. This form may be duplicated in blank and/or sent via facsimile transmission. This authorization is a continuing authorization about my loan, including duplicates of any notices sent to me about my loan.
Borrower:
Sign: X___________________________________
DOB: _______________________
SSN: ________________________
Mother's Maiden Name: ________________________
Borrower:
Sign: X__________________________________
DOB: ________________________
SSN: _________________________
Mother's Maiden Name: _________________________
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