Mac Form 710 - Uniform Borrower Assistance Form Page 16
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TH IR D - PA R T Y AU THOR I ZAT IO N FO RM
Loan Number:
Use this Third Party Authorization form to authorize someone other than yourself to access your Flagstar Bank Mortgage Loan Account
information. To authorize full access to your loan account, this from must be notarized (see page 2).
In today’s market, loans and the rights to service them are often bought and sold. Servicing transfers may occur at any time. In the event your
loan is transferred to a new servicer, the authorization established by this form will no longer be effective. You will need to contact your new
servicer to obtain their authorization procedures. Our liability/obligations remain to the customer and the presence of a representative should
not create additional direct or derivative liability for the Bank.
Please PRINT – for multiple mortgage loan accounts use separate forms.
Section 1- Your Contact and Mortgage Loan Account Information
First Name
Middle Name
Last Name
Last 4 Digits of Social Security Number
Best Phone Number
Section 2- Authorized Third Party
Expiration date for authorization:
Loan Maturity
or
Input Date:
(Note: If no date is selected, the authorization will be valid for two years from the date signed below)
Type of Authorization:
Individual
Company
Authorization Description:
Realtor
Attorney
Appraiser
Other:
Name (Please note: It is not necessary to list individual names for a company authorization)
Address
City
State
Zip
Best Phone Number
Fax
Email
Select a PIN for the Authorized Individual: (A PIN is not needed for a company)
(continued on back)
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Rev. 1014
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