3rd Party Authorization Form - Veripro Solutions

1 Contact Us: Phone: 888-967-9700. Email: Fax: 877-492-6160. 3rd party authorization form ( please complete the information below, sign and return by FAX, email or USPS.). Today's Date: _____. Borrower Name: _____ Co-Borrower Name:_____. Account Number: _____. Property Street Address: _____. City: _____ State: _____ Zip: _____. I/We authorize Veripro Solutions to provide the following information regarding the above- referenced loan to the Authorized Party listed below: Authorized Party 1. Name: _____ Company (If Applicable): _____. Email Address: _____ Phone Number: _____. Street Address: _____ City: _____ State: _____ Zip: _____. Relationship to Borrower: _____. Authorized Party 2. Name: _____ Company (If Applicable): _____. Email Address: _____ Phone Number: _____. Street Address: _____ City: _____ State: _____ Zip: _____. Relationship to Borrower: _____.

2 This Authorization is valid for the following: ___ Valid 90 days from the date above. ___ Valid until revoked by the undersigned or when the loan is paid in full ___ Access to discuss all information regarding my loan ___ Other ( please specify): _____. _____ _____. Borrower Signature Co-Borrower Signature Notice: Important state disclosure information on page 2. 750 E Highway 121, Suite 100, Lewisville, TX 75067 | Box 3244, Coppell, TX 75019 |Phone: 888-967-9700 |Fax: 877-492-6160. |Business Hours: 8AM to 8PM CST| |Se Habla Espa ol Veripro Solutions Inc.(formerly known as NSM Recovery Services Inc.) is a Nationstar Mortgage LLC company. Veripro is a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose. However, if you are currently in bankruptcy or have received a discharge in bankruptcy, this letter is not an attempt to collect a debt from you personally to the extent that it is included in your bankruptcy or has been discharged but is provided for informational purposes only.

3 If you are represented by an attorney, please provide this notice to your attorney CONSUMER NOTICE: The account in connection with the above-referenced collateral address has been placed with Veripro Solutions Inc. (" Veripro ") for purposes of negotiating a debt settlement and collections. MASSACHUSETTS: NOTICE OF IMPORTANT RIGHTS: YOU HAVE THE RIGHT TO MAKE A WRITTEN OR ORAL REQUEST. THAT TELEPHONE CALLS REGARDING YOUR DEBT NOT BE MADE TO YOU AT YOUR PLACE OF. EMPLOYMENT. ANY SUCH ORAL REQUEST WILL BE VALID FOR ONLY TEN DAYS UNLESS YOU. PROVIDE WRITTEN CONFIRMATION OF THE REQUEST POSTMARKED OR DELIVERED WITHIN. SEVEN DAYS OF SUCH REQUEST. YOU MAY TERMINATE THIS REQUEST BY WRITING TO THE. CREDITOR. NEW YORK: This collection agency is licensed by the Department of Consumer Affairs of the City of New York;. License# 1380709. NORTH CAROLINA: This collection agency is licensed by the North Carolina Department of Insurance; License #.

4 104627. TENNESSEE: This collection agency is licensed by the Tennessee Collection Service Board of the Department of Commerce and Insurance. IDAHO: Only for correspondence where the creditor is Nationstar Mortgage, see the following disclosure: The creditor has a managerial or financial interest in this collection agency. 750 E Highway 121, Suite 100, Lewisville, TX 75067 | Box 3244, Coppell, TX 75019 |Phone: 888-967-9700 |Fax: 877-492-6160. |Business Hours: 8AM to 8PM CST| |Se Habla Espa ol Veripro Solutions Inc.(formerly known as NSM Recovery Services Inc.) is a Nationstar Mortgage LLC company. Veripro is a debt collector. This is an attempt to collect a debt and any information obtained will be used for that purpose. However, if you are currently in bankruptcy or have received a discharge in bankruptcy, this letter is not an attempt to collect a debt from you personally to the extent that it is included in your bankruptcy or has been discharged but is provided for informational purposes only.

5 If you are represented by an attorney, please provide this notice to your attorney