Chase Authorization Form – Fill Out and Use This PDF

Updated: Nov 9, 2026

The Chase Authorization Form is a crucial document for borrowers who wish to allow Chase or its authorized representatives to share information about their mortgage with third parties. This form outlines the process for borrowers to grant Chase the permission needed to release, furnish, and request information related to their loan to specified parties. Whether you're managing your mortgage details or coordinating with third parties regarding your loan, completing and submitting this form is an essential step in ensuring clear communication and authorized information sharing.

To easily manage your mortgage details and authorize information sharing, click the button below to fill out the Chase Authorization Form.

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How to Fill Out Authorization to Provide and Release Information

Authorization to Provide and Release Information at a glance

What it is: The Authorization to Provide and Release Information form will allow Chase or its authorized representative to share information about your mortgage with third parties.

Who signs: The borrower(s) sign: under Signed by, each borrower provides the Signature, the Printed Name and the Date.

The borrower(s) hereby authorize Chase to release, furnish, provide, exchange and request information related to the loan to the Authorized Third Party/Parties.

A filled-in Authorization to Provide and Release Information example: co-borrowers authorize two third parties

Authorization to Provide and Release Information example filled out, example: co-borrowers authorize two third parties — Dana and Sam Sample, co-borrowers, fill out the Chase authorization form. They name two third parties, and the authorization is valid until December 31, 2027. The picture shows page 1, and all its values are invented.

How to fill out Authorization to Provide and Release Information, box by box

Loan number, date, borrowers and property address

Fill in the LOAN NUMBER, the DATE, the BORROWERS and the PROPERTY ADDRESS.

I/We, currently residing at, in the County of, State of

Write the borrower(s) name(s), then where they are currently residing, the County and the State.

Authorized Third Party/Parties

Under Authorized Third Party/Parties, provide the Name of Third Party, the Address, the Phone Number and the Email Address for Third Party #1 and for Third Party #2.

Expiration of Authorization

If applicable, specify a period of time or the particular transaction for which the authorization is valid. If no expiration date or operational transaction is provided, this authorization will remain valid until revoked in writing.

You may revoke this authorization at any time by providing written notice to Chase.

Signed by

The borrower(s) sign: under Signed by, each borrower provides the Signature, the Printed Name and the Date.

The signers hereby indemnify and forever hold Chase harmless from any and all actions and causes of actions, suits, claims, attorney's fees, or demands against Chase.

More rules for Authorization to Provide and Release Information

If you have any questions about the form, please call Chase at 1-800-848-9136 or by TTY at 1-800-582-0542.

Sources

[1] Chase Authorization to Provide and Release Information (the served file; no issuer file found) (the Official source link on this page).

Chase Authorization Form PDF Details

The Chase Authorization Form lets mortgage borrowers grant Chase permission to share their loan information with named third parties. By completing this form, borrowers authorize Chase to release, furnish, provide, and exchange specific details about their mortgage with individuals or entities they designate in writing.

To fill out the form correctly, borrowers must include their loan number, property address, and full name(s). The form also requires complete contact information for each authorized third party, including their name, address, phone number, and email address. Providing accurate details ensures that only named parties receive access to the shared information.

Borrowers can specify a particular timeframe or transaction during which the authorization remains valid. If no timeframe is specified, the authorization continues until the borrower cancels it in writing. The form also includes an indemnification clause that protects Chase from legal claims related to sharing authorized information. Borrowers must sign and date the document to make the authorization effective. Chase contact details are included on the form in case questions arise during the process.

Question	Answer
Form Name	Chase Authorization Form
Form Length	1 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	15 sec
Other names	chase authorization release, chase address hereby, chase authorization to release information form, chase direct deposit authorization form