Third Party Authorization Form

    Complete this form to designate a third party to act or provide information on your behalf.

    Part A - Personal Information

    Part A - Business Information

    Part B - Third Party Representative Information


    1. I authorize MetCredit and its agents to discuss, correspond, disclose and release any and all information pertaining to the aforementioned accounts and discuss relevant matters pertaining to me with the third party identified above.
    2. This authorization is effective as of the date submitted and is to remain in effect until I provide written direction to cancel the authority granted.

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