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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 assigns.
This form may be duplicated in blank and/or sent via fasimile transmission. This authorization is a
continuing authorization for said parties to receive information about my loan, including
duplicates of any notices sent to me regarding my loan.
Borrower:
Sign: x_______________________________________________ DOB: ________________________
Print Name:
SSN: _________________________
Mother's Maiden Name: _________________________
Borrower:
Sign: x_______________________________________________ DOB: ________________________
Print Name:
SSN: _________________________
Mother's Maiden Name: _________________________
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