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THIRD-PARTY AUTHORIZATION FORM
flagstar.com
Loan Number:
**********
Rev. 0417
Complete and sign this Third Party Authorization form to authorize someone other than yourself to access your Flagstar Bank
Mortgage Loan Account information. IMPORTANT: Once completed and signed , please mail or fax to:
Mail: Flagstar Bank | Third Party Authorization | E-115-3 | 5151 Corporate Drive | Troy, MI 48098 Fax: (888) 848-1071
Please PRINT
Section 1- Your Contact and Mortgage Loan Account Information
First Name Middle Name Last Name
Last 4 Digits of Social Security Number
Best Phone Number
Section 2- Authorized Third Party
Expiration date for authorization:
*
Loan maturity or
*
Input date:
(Note: If no date is selected, the authorization will be valid for two years from the date signed below)
Type of Authorization:
*
Individual
*
Company
Authorization Description:
*
Realtor
*
Attorney
*
Appraiser
*
Other:
Name (Please note: It is not necessary to list individual names for a company authorization)
Address City State Zip
Best Phone Number Fax Email
Section 3- Your Authorization
The authorized third party can:
• Obtain loan details information by telephone
• Discuss payment arrangements with the Collections Department
• Discuss the Loss Mitigation application process
• Submit request to send documents that do not require a fee, such as a Transaction History Ledger, or an Original Appraisal.
(can only be mailed to address of record)
• Submit request to re-send letter/package/document, such as a Monthly Statement, 1098, Escrow Analysis Disclosure, Rate/Payment,
Change Notice, Loan Sale Transfer Notice, etc. (can only be mailed to address of record.)
• Request research to resolve matters
By signing this form, I authorize Flagstar Bank to provide loan information regarding the Mortgage Loan Account referenced above
to the Authorized Party or to someone claiming to be the Authorized Party. I understand that this Third Party Authorization allows only for information
to be provided by telephone and the actions described above. Flagstar may reject this or any other Third Party Authorization or refuse to recognize
any request for information from the Authorized Party. This Third Party Authorization shall remain in effect until I revoke this authorization. I or any
other borrower on this loan may revoke this Third Party Authorization at any time in writing via fax or mail.
In the event your loan is transferred to a new servicer, the authorization established by this form will no longer be effective. Our liability/obligations
remain to the customer and the presence of a representative should not create additional direct or derivative liability for the Bank.
Borrower Signature: Date:
Co-borrower Signature: Date:
click to sign
signature
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