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Get CHASE Authorization to Provide and Release Information

AUTHORIZATION TO PROVIDE AND RELEASE INFORMATION This Borrower Authorization form will allow Chase or its authorized representative to share information about your mortgage with third parties. You may revoke this authorization at any time by providing written notice to Chase. I/We hereby indemnify and forever hold Chase harmless from any and all actions and causes of actions suits claims attorney s fees or demands against Chase which I/we and/or my/our heirs may have resulting from Chase discussing or declining to discuss my/our account with the above-named requestor or person identifying himself/herself to be that requestor or resulting from providing or declining to provide any documents or other information concerning the account to the requestor. Signed by Signature Printed Name Date If you have any questions about the form please call us at 1-800-848-9136 or by TTY at 1-800-582-0542. TO LOAN NUMBER DATE BORROWERS PROPERTY ADDRESS Chase my Loan I/We borrower s name s currently residing at in the County of furnish provide exchange and request information related to my/our loan to Authorized Third Party/Parties Name of Third Party 1 Address Phone Number Email Address And I We hereby authorize Chase to release furnish provide exchange and request information related to the account above to the Authorized Third Party identified above. Expiration of Authorization If applicable please specify a period of time or the particular transaction for which the authorization is valid. If no expiration date or operational transaction is provided this authorization will remain valid until revoked in writing. Expiration of Authorization If applicable please specify a period of time or the particular transaction for which the authorization is valid. If no expiration date or operational transaction is provided this authorization will remain valid until revoked in writing. You may revoke this authorization at any time by providing written notice to Chase. I/We hereby indemnify and forever hold Chase harmless from any and all actions and causes of actions suits claims attorney s fees or demands against Chase which I/we and/or my/our heirs may have resulting from Chase discussing or declining to discuss my/our account with the above-named requestor or person identifying himself/herself to be that requestor or resulting from providing or declining to provide any documents or other information concerning the account to the requestor. TO LOAN NUMBER DATE BORROWERS PROPERTY ADDRESS Chase my Loan I/We borrower s name s currently residing at in the County of furnish provide exchange and request information related to my/our loan to Authorized Third Party/Parties Name of Third Party 1 Address Phone Number Email Address And I We hereby authorize Chase to release furnish provide exchange and request information related to the account above to the Authorized Third Party identified above. Expiration of Authorization If applicable please specify a period of time or the particular transaction for which the authorization is valid* If no expiration date or operational transaction is provided this authorization will remain valid until revoked in writing. .

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