REQUEST AUTHORIZATION FORM
(PROXY OR CONSENT)

You will receive a form to authorize someone else to obtain personal information in your file or to act on your behalf. Please allow for processing time.

If you already have a Customer Space, you can designate an authorized person directly via your Customer Space. If you don’t have a Customer Space, you can verbally designate an authorized person by contacting us.

Fields marked with an asterisk (*) must be filled in.

Account holder

Name of account holder or, if the holder is a company, signing officer on file:

Courtesy title

Type of account