[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-347894-105":59,"doc-detail-347894-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","authorization-to-furnish-and-release-information-consent-form","Authorization to Furnish and Release Information - Consent Form","","Authorization consent form granting JPMorgan Chase Bank, N.A. permission to furnish, release, and provide account-related information to a named third party. Includes blanks for account number, customer name, property address, and the third party’s name, address, and phone number. Explains authentication steps, validity until revoked, instructions to revoke by mail or phone, and indemnification holding Chase harmless for actions involving disclosure or refusal.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":40,"@type":76,"position":81},"https://docshare.wps.com/document/research-report/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/authorization-to-furnish-and-release-information-consent-form/347894/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/authorization-to-furnish-and-release-information-consent-form/347894.png","ImageObject",300,407,{"name":92,"@type":93},"Ben ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-09-26","2026-09-22",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What does this authorization allow JPMorgan Chase to do?","Question",{"text":112,"@type":113},"It authorizes JPMorgan Chase Bank, N.A. to release, furnish, and provide account-related information to the specified third party.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How long does the authorization remain valid?",{"text":117,"@type":113},"The authorization remains valid until the customer revokes it.",{"name":119,"@type":110,"acceptedAnswer":120},"How can the customer revoke the authorization?",{"text":121,"@type":113},"The customer can revoke the authorization by writing or calling using the contact information provided in the form.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},347894,1790377792,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":39,"category_name":40,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24},2336478951081,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","AUTHORIZATION TO FURNISH AND RELEASE INFORMATION  \nChase Account Number:    \nDate:    \nCustomer Name(s):    \nProperty Address:    \n__________________________  \nI/We,   (customer name [s]), currently residing at   (current address), County of   , State of   , hereby authorize JPMorgan Chase Bank, N.A. (“Chase”) to release, furnish, and provide information related to my/our account number   (loan number) to:  \n_____________________________________________________________________________________  \n_____________________________________________________________________________________  \n(“Third Party”) (Include the name, address, and telephone number of the Third Party) .  \nPlease complete if applicable: If the Third Party listed above is a counseling organization, corporation, law firm, or entity other than a natural person, you may provide the name(s) of the specific individual(s) working for the Third Party to whom Chase is authorized to release information. If no individuals are specified below, and your authorization is not otherwise restricted, your authorization will be applied to your entire file and the entire entity.  \nI/We authorize Chase to provide my/our information to the following individual(s) at the Third Party:  \n_____________________________________________________________________________________  \n_____________________________________________________________________________________  \nChase will take reasonable steps to authenticate the identity of the Third Party authorized above; however, we will not have any liability if we decline to release your account information because we are unable to authenticate the true identity of the authorized requestor seeking account information.  \nThis authorization will remain valid until revoked. To revoke your authorization, please write or call us using the contact information below.  \nI/We hereby indemnify and forever hold Chase harmless from any and all actions and causes of actions, suits, claims, attorney’s fees, or demands against Chase, which I/we and/or my/our heirs may have resulting from Chase discussing, or declining to discuss, my/our account with the above-named requestor or person identifying himself/herself to be that requestor, or resulting from providing, or declining to provide, any documents or other information concerning the account to the requestor.  \nSigned by:  \n(Signature) (Date)  \n(Printed Name)  \nSigned by:  \n(Signature) (Date)  \n(Printed Name)  \nPlease return this completed form to:  \nRegular mail: Chase  \nMail Code OH4-7302  \nP.O. Box 24696  \nColumbus, OH 43224-0696  \nOvernight mail: Chase  \nAttn: Third Party Authorization Research  \n710 South Ash Street, Suite 200  \nGlendale, CO 80246-1989  \nFax: 1-614-422-7575 (Free of charge from any Chase branch) If you have questions on the form, please call us at 1-800-848-9136. We accept operator relay calls.  \nCR46236-BE FM10 1 IC20-1418_0120","cbCaig7hqWyfWHWf","https://ap.wps.com/l/cbCaig7hqWyfWHWf","pdf",104587,"English","# Authorization Scope\n## Third Party Information\n## Authentication and Liability\n## Validity and Revocation\n## Indemnification and Signatures\n## Return Address","[{\"question\":\"What does this authorization allow JPMorgan Chase to do?\",\"answer\":\"It authorizes JPMorgan Chase Bank, N.A. to release, furnish, and provide account-related information to the specified third party.\"},{\"question\":\"How long does the authorization remain valid?\",\"answer\":\"The authorization remains valid until the customer revokes it.\"},{\"question\":\"How can the customer revoke the authorization?\",\"answer\":\"The customer can revoke the authorization by writing or calling using the contact information provided in the form.\"}]","Authorization to Furnish and Release Information - Consent Form | PDF",1790069679]