Information Release Authorization Form

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INFORMATION
Correspondence:
PO Box 5209
Helena MT 59604-5209
Payments:
PO Box 1689
RELEASE
Helena MT 59624-1689
Phone:
(800) 852-2761
Fax:
(406) 495-7880
AUTHORIZATION
Website:
SECTION 1: BORROWER/ENDORSER IDENTIFICATION
Name: ________________________________________
Account Number: ____________________________
Address: ______________________________________
Telephone-Home: ____________________________
______________________________________
Telephone-Other: ____________________________
City, State, Zip Code: ____________________________
Email Address: ______________________________
SECTION 2: RELEASE FOR INFORMATION
I,
______________, do hereby give permission to Student
Assistance Foundation (SAF) to release any and all information regarding my student loan(s) to any
individuals identifying themselves orally or in writing as the following party:
_______________________________________________________
_________________________
Name (Company or Individual)
Relationship
_______________________________________________________
_________________________
Street Address
Phone Number
_______________________________
________________________________
_______________
City
State
Zip
SECTION 3: BORROWER/ENDORSER UNDERSTANDINGS AND CERTIFICATIONS
I understand that by signing this form, I am giving SAF permission to release requested information
regarding my student loan(s), and I hereby release SAF and my lender from any and all liability in
connection with release of such information to such person(s). SAF has no duty to inquire as to the reason
why such information is requested, and no affirmative duty to disclose to me that it has provided such
information. I also understand this authorization does not require Student Assistance Foundation to release
any information, nor does it prevent SAF from exercising its independent judgment with respect to releasing
information.
I understand that my granting permission to release information does not release me as the signatory on my
student loan(s) from the responsibilities associated with being the signatory.
I authorize the school, the lender, the guarantor, the Department, and their respective agents and
contractors to contact me regarding my loan(s), including repayment of my loan(s), at the current or any
future number that I provide for my cellular telephone or other wireless device using automated telephone
dialing equipment or artificial or prerecorded voice or text messages
This release will remain in effect until said authorization is revoked by me in writing. If this release is for a
business, it is only applicable for a 30-day period.
Borrower Signature __________________________________________________ Date ____________________
Return the completed form and any required documentation to:
Mail: Student Assistance Foundation
Email:
PO Box 5209
Helena MT 59604-5209
Fax:
(406) 495 - 7880

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