Chase Authorization Form PDF Details

A Chase Authorization Form must be completed by the cardholder when they are requesting a charge to be authorized against their credit or debit card. The form authorizes the merchant to charge the card for the purchase amount and can help protect you against any fraud or unauthorized charges. Completed forms can be faxed, mailed, or e-mailed to the merchant. It is important to keep a copy of the form for your records in case there are any disputes about the charges.

QuestionAnswer
Form NameChase Authorization Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other nameschase authorization release, chase address hereby, chase authorization to release information form, chase direct deposit authorization form

Form Preview Example

AUTHORIZATION TO PROVIDE

AND RELEASE INFORMATION

This Borrower Authorization form will allow Chase or its authorized representative to share information about your mortgage with third parties.

TO:

Chase

LOAN NUMBER:

____________________________ (“my Loan”)

DATE:

____________________________

BORROWERS:

____________________________

PROPERTY ADDRESS:

____________________________

 

____________________________

I/We, ________________________________________________ (borrower(s) name(s)),

currently residing at ____________________________________________ in the County of

___________________________, State of _____________________, hereby authorize Chase to release,

furnish, provide, exchange and request information related to my/our loan to:

Authorized Third Party/Parties

Name of Third Party #1:__________________

Name of Third Party #2: ___________________

Address : ______________________________

Address: _________________________________

______________________________

________________________________

Phone Number: _________________________

Phone Number: ___________________________

Email Address: _________________________

Email Address: ___________________________

And, I (We) hereby authorize Chase to release, furnish, provide, exchange and request information related to the account above to the Authorized Third Party identified above.

Expiration of Authorization

If applicable, please 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.

I/We 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, which I/we and/or my/our heirs may have resulting from Chase discussing, or declining to discuss, my/our account with the above-named requestor or person identifying himself/herself to be that requestor, or resulting from providing, or declining to provide, any documents or other information concerning the account to the requestor.

Signed by:

Signed by:

_______________________________________

_______________________________________

(Signature)

(Signature)

_______________________________________

_______________________________________

(Printed Name)

(Printed Name)

_______________________________________

_______________________________________

(Date)

(Date)

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

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chase direct deposit authorization form completion process shown (portion 1)

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A way to fill out chase direct deposit authorization form stage 2

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