Authorization Form
3rd Mortgage We, the undersigned, hereby authorize you to release information regarding the referenced loan to Loan Repair and Rescue and/or their agents or assigns. This form may be duplicated in blank and/or sent via facsimile transmission. This authorization is a consenting authorization for said parties to receive information about my loan, including duplicate of any notices sent to me regarding my loan. This is in accordance with Title 24 of the CFR 203.500 (HUD)
Lender: 1st Loan Number:
Phone Number of Lender: Borrower's Full Name: Co-Borrower's Full Name: Property Street address: City, State, Zip: Borrower's Social Security #: Co-Borrower's Social Security #:
Borrower signature: __________________________ Co-Borrower Signature: _______________________
Date:_____________ Date:_____________