Third Party Authorization Release Form

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THIRD PARTY AUTHORIZATION RELEASE FORM
BC FINANCIAL GROUP
P.O. BOX 370183 MONTARA, CA 94037
650.740.3553
FIN: 03-0405772
Date: ________________________
Borrower(s) Contact Information:
Borrower: ______________________________
Co-Borrower:_______________________________
Mailing Address: _____________________________________________________________________
Property Address: ____________________________________________________________________
Lender/Loan Information:
Loan Number: ___________________________ Name of Lender: ____________________________
Lender Contact Number: ______________________________________________________________
To whom it may concern:
BC Financial Group (Frank Welch/Kimberly Smith/Sally Gustavson)
I/We hereby authorize
to act as
my/our representatives in negotiations and correspondence with my/our mortgage company/servicer
listed above. This will include, but is not limited to: all payment records, loan documents, disclosures,
records, life of loan history, letters of explanation, foreclosure, short sale and any other asset balances
to help process a loan workout/modification/mortgage. It is understood that a copy of this form will
also serve as authorization. This authorization may be duplicated and/or sent via facsimile transmission.
This authorization is a continuation authorization for said persons to receive information regarding
my/our loan, including any duplicates of any notices sent to me/us regarding this loan. The information
that BC Financial Group obtains is only to be used in the processing of my loan
workout/modification/mortgage and shall be in effect for one year from the start date of this request.
By signing below, I/We hereby authorize ______________________ to discuss the above mentioned
information on the referenced loan with the representatives designated for BC Financial Group.
_____________________________________________________
___________________
Borrower Signature
Date of Birth
______________________________
Social Security Number
_____________________________________________________
___________________
Co-Borrower Signature
Date of Birth
______________________________
Social Security Number

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