Authorization To: Receive Customer Information or Act on a ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and title (if applicable) in the designated fields at the top of the form.
3. Provide your mailing address, ensuring all details are accurate for effective communication.
4. Next, appoint your agent by filling in their name and mailing address. This person will act on your behalf.
5. List the accounts included in this authorization by entering the service addresses and account numbers as required.
6. Indicate which specific acts and functions you authorize your agent to perform by initialing the applicable boxes.
7. Select the type of authorization you wish to grant—one-time, one-year, or a specified duration—and fill in any necessary dates.
8. Finally, sign and date the form where indicated, ensuring that you have authority to bind the customer legally.

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