Authorization to Release Information

1st Lender: ___________________________________________________

Loan Number: ________________________________________________
2nd Lender: __________________________________________________
Loan Number: ________________________________________________
Property Address: _____________________________________________
City/State/Zip: ________________________________________________

I authorize you to release to [YOUR NAME] dba [YOUR COMPANY NAME OR

YOUR NAME] at telephone [YOUR PHONE NUMBER] and fax [YOUR FAX
NUMBER] and or [ASSISTANTS NAME] any and all information, including payoffs,
principal or escrow/impound balances, foreclosure dates, and any other pre-foreclosure
information that he/she may require about my loan for the above referenced property.
Should there be any question as to the authenticity of this document you may contact me
at the information provided below so I may confirm that I have given these parties
permission to speak to you on my behalf.
X__________________________________________________________
Borrower Signature
X__________________________________________________________
Borrower Full Name (Printed)
X__________________________________________________________
Second Borrower Signature
X__________________________________________________________
Second Borrower Full Name (Printed)
X__________________________________________________________
Last 4 digits of Social Security Number for First Borrower
X__________________________________________________________
Last 4 digits of Social Security Number for Second Borrower
X__________________________________________________________
Date of Birth First Borrower
X__________________________________________________________
Date of Birth Second Borrower
X__________________________________________________________
Contact Telephone Number