Third Party Authorization Form Template
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Third Party Authorization Form

Please complete this Third Party Authorization Form Template to officially grant permission for a third party to act on your behalf.

Mortgage Lender/Servicer Name (Servicer)

    Account Number

    Loan Number

      Authorized Third Party Contact Information

      Please fill in the information below.

      Name

        Email

        example@example.com

          Name of the Entity, Agency, Firm,(If Applicable)

            Address of Entity, Agency, Firm (If Applicable)

              The undersigned, on behalf of the Third Party, Acknowledges the accuracy and compatibility of the above information. A false statement or omission of truth may result in civil/criminal punishment.

              I declare that I understand and agree with the terms of this third party authorization

                Borrower Signature

                Date: Date

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