Third Party Authorization Form

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

Authorization is for: PersonalBusiness

Part A - Personal Information

First name*

Last name*

Account #*

Date of Birth (YYYY-MM-DD)

Phone

Cellphone*

Email*

Preferred contact method:
PhoneEmail

Address

City

Province/State

Postal/Zip Code

Country

Is this your mailing address?
YesNo

Mailing address if different

City

Province/State

Postal/Zip Code

Country

Part A - Business Information

True Corporate Name*

Trade Name

Contact Person*

Contact Person's Title*

Contact Person's Phone*

Contact Person's Email*

Business Phone*

Preferred contact method:
PhoneEmail

Account #*

Address*

City*

Province/State*

Postal/Zip Code*

Country*

Is this the mailing address?
YesNo

Mailing address if different

City

Province/State

Postal/Zip Code

Country

Part B - Third Party Representative Information

Choose one*

First Name*

Last Name*

Phone*

Cellphone

Email*

Address*

City*

Province/State*

Postal/Zip Code*

Country*

Is this your mailing address?
YesNo

Mailing address if different

City

Province/State

Postal/Zip Code

Country

Authorization

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.
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.

Date (YYYY-MM-DD)*

Full Name*

By checking this box and clicking "Submit", I acknowledge that I am offering a digital signature and that I assume any liability to the above-mentioned account and document and that all information herein is correct and complete.

Part A - Personal Information

Part A - Business Information

Part B - Third Party Representative Information

Authorization

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