The Borrower collectively and individually agrees that except for obtaining the last five 5 digits of the or responsibility whatsoever to verify the identity of the Recipient or any of them and releases and holds the Bank harmless from any and all claims responsibility or liability whatsoever related to in connection with or arising out of the Bank s release of information under this authorization. Borrower Print Borrower Sign Date Fax signed form to 601 554-2011 or mail to Regions Mortgage Attn. Customer Service P. Loan Number Primary Borrower Secondary Borrower Authorization Form to Provide Information to For security validation purposes I/we are providing and certify that the last five 5 digits of the above authorized party s Social Security or Taxpayer Identification Number is The best contact telephone number s for the above authorized party is/are This authorization form must be executed by all borrowers and will remain in effect until revoked in writing by one or more borrowers. I/We the undersigned individually and collectively the Borrower hereby authorize and request Regions Bank dba Regions Mortgage the Bank to share release discuss and otherwise provide to the above designated individual s and any of his her or its agents successors or assigns collectively the Recipient any and all public and non-public personal financial or other information of or relating to the Borrower or any of them in the Bank s possession or to which the Bank may have access. Loan Number Primary Borrower Secondary Borrower Authorization Form to Provide Information to For security validation purposes I/we are providing and certify that the last five 5 digits of the above authorized party s Social Security or Taxpayer Identification Number is The best contact telephone number s for the above authorized party is/are This authorization form must be executed by all borrowers and will remain in effect until revoked in writing by one or more borrowers. I/We the undersigned individually and collectively the Borrower hereby authorize and request Regions Bank dba Regions Mortgage the Bank to share release discuss and otherwise provide to the above designated individual s and any of his her or its agents successors or assigns collectively the Recipient any and all public and non-public personal financial or other information of or relating to the Borrower or any of them in the Bank s possession or to which the Bank may have access. Such information may include but is not limited to name address telephone number social security number credit score income government monitoring information loan status account balances and payment activity of the Borrower or any of them* Such information may be provided whether such information is the result of the Bank s experience with the Borrower or any of them or is contained in a loan application in financial statements in consumer business or commercial credit reports in any other third party reports in verification forms or wherever and however such information may be held by the Bank.