Letter Of Authorization

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LETTER OF AUTHORIZATION
By this document, it is hereby acknowledged, that I/We, the undersigned (“CLIENT” and/or
“CO-CLIENT”), do hereby grant limited and specific authorization to the United Consumer
Advocacy Network, its representatives, and/or assigns (“UCAN”), for the specific purposes as
listed within this document.
UCAN shall have authority to discuss, release or obtain any personal information relating
to my credit, debt, assets, and any other financial information.
This authority shall also include any incidental acts that are reasonably required to carry
out and perform the specific authorities herein granted.
Further, I authorize and instruct any and all of my unsecured creditors to discuss my
account(s) with UCAN.
This authorization shall be effective upon signing. While this authorization may be revoked by
the CLIENT and/or CO-CLIENT at any time, it will automatically terminate upon completion of
services by UCAN.
A copy or facsimile shall have the same force and effect as the original.
______________________________
____________________________ ______________
CLIENT Name (Please Print)
CLIENT Signature
Date
______________________________
____________________________ ______________
CO-CLIENT Name (Please Print)
CO-CLIENT Signature
Date
For Notary Use Only
Notary Signature: ____________________________________
Printed Name: _______________________________________
Executed this ______ day of ________________, ________
In the county of _______________, state of _______________

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