THIRD-PARTY AUTHORIZATION FORM

Financial institution authorization

1. PRINCIPAL (ACCOUNT HOLDER) DETAILS

2. AUTHORIZED THIRD PARTY DETAILS

Securely provided for verification

3. ID & DOCUMENT UPLOAD (Third Party ID Required)

Upload front side of government-issued ID
Upload back side of ID
Supporting documents: signed letter, power of attorney, etc.

4. SCOPE OF AUTHORIZATION

6. DURATION OF AUTHORIZATION

7. DECLARATION & SIGNATURE

I, the undersigned account holder, hereby authorize the above-named third party to act within the scope defined in this document. I understand that this authorization is subject to all applicable laws and financial institution policies.