Housing Counseling Authorization Form
We are glad that you have an interest in our housing counseling! We offer a variety of housing workshops and housing counseling! Please fill out the form below to authorize us to help you with your housing issues.
Housing Counseling Authorization Form
"*" indicates required fields
Date
Loan servicer *
Account # *
Borrower name *
Borrower name *
Co-borrower name
Co-borrower name
Property address *
Property address
City *
State *
ZIP Code *
I/We,
-
do hereby authorize Servicer to release any and all information about any and all of my account(s) to any representative of Pioneer Credit Counseling I understand that the information released by the Servicer may include, but is not limited to, information relating to my loan amount and payment transactions and/or provision of copies of any and all loan documents and communication history associated with my account (s) in the possession of Servicer. Under no circumstances will I hold Servicer's provision of information pursuant to the terms of this agreement. Borrower further authorizes Servicer to speak with any representative with Pioneer Credit Counseling regarding all aspects of my account (s) and account history, including information provided by any prior servicer. Borrower also authorizes Servicer to notify Pioneer Credit Counseling in the event that my/our loan payments become delinquent in the future, or if a loss mitigation workout is discussed, implemented, completed and /or results in default. Pioneer Credit Counseling agrees to maintain the confidentiality of borrower (s) information. I acknowledge that this authorization will remain in effect for the duration of time that Servicer serves as the loan servicer for my account (s). I also acknowledge that should I wish to terminate this authorization, I will notify Servicer in writing. This authorization will not be valid unless signed below by borrower and all co-borrowers named above.
Primary borrower
Primary borrower
Last four digits of SSN
Signature
Date
Co-borrower name
Co-borrower name
Last four digits of SSN
Signature
Date