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Third Party Authorization

Fill in all required field(s) below*

The following fields need to be corrected:*

Loan number:

Borrower(s) Name: (#000000)

Property address:

Please check each applicable box:

Authorization for to disclose and release information on my (our) behalf regarding the above claim, inspection requests, and/or related repairs to the below authorized party.

Authorization for to mail draw checks directly to the below authorized party.

Authorized Party Name:

Authorized Party Phone Number:

Authorized Party Address:

NOTE: Loan information such as payment status, loan type, etc., is not included within this authorization.

This authorization will become effective as of the date signed and will terminate at which time the claim has been completed and closed by .

Borrower signature

Date

Co-Borrower signature

Date

Third Party Authorization

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