Mac Form 710 - Uniform Borrower Assistance Form Page 17

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TH IR D - PA R T Y AU THOR I ZAT IO N FO RM
Loan Number:
Section 3- Type of Access
Please select one option below (partial or full access):
Partial Access
Can obtain loan details information by telephone
Can discuss payment arrangements with the Collections Department
Can discuss the Loss Mitigation application process
By signing this form, I authorize Flagstar Bank to provide information regarding the above referenced Mortgage Loan Account by telephone
to the Authorized Party or to someone claiming to be the Authorized Party. I understand that this authorization does not allow the Authorized
Party to take any action or request any service or documentation on this loan. Flagstar may reject this or any other Third Party Authorization or
refuse to recognize any request for information from the Authorized Party. This Third Party Authorization shall remain in effect until I revoke this
authorization. I or any other borrower on this loan may revoke this Third Party Authorization at any time in writing via fax or mail.
Signature:
Date:
Full Access
Can obtain loan details information by telephone
Can discuss payment arrangements with the Collections Department
Can discuss the Loss Mitigation application process
Can submit request to send documents that do not require a fee, such as a Transaction History Ledger, or an Original Appraisal.
(can only be mailed to address of record)
Can submit request to re-send letter/package/document, such as a Monthly Statement, 1098, Escrow Analysis Disclosure, Rate/Payment,
Change Notice, Loan Sale Transfer Notice, etc. (can only be mailed to address of record.)
Can request research to resolve matters
By signing this form, I authorize Flagstar Bank to provide loan information regarding the Mortgage Loan Account referenced on page 1
to the Authorized Party or to someone claiming to be the Authorized Party. I understand that this Third Party Authorization allows only for
information to be provided by telephone and the actions described above. Flagstar may reject this or any other Third Party Authorization or
refuse to recognize any request for information from the Authorized Party. This Third Party Authorization shall remain in effect until I revoke
this authorization. I or any other borrower on this loan may revoke this Third Party Authorization at any time in writing via fax or mail.
Signature:
Date:
Notary witness and official seal for Full Access
(Notary Seal)
Date
Notary Signature
County
My Commission Expires On
IMPORTANT INFORMATION:
Once completed and signed (and notarized, if applicable), please mail or fax to:
Mail: Flagstar Bank | Third Party Authorization | Mail Stop E-115-3 | 5151 Corporate Drive | Troy, MI 48098 Fax: (888) 848-1071
Member FDIC
2 of 2
Rev. 1014

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