Customer Mortgage

OneMain

**** ********* **, ***** ***

Mendota Heights, MN 55120

800-***-****

Authorization to Release Information

Customer Name(s): Address:

I hereby authorize OneMain to obtain the following information:

• Employment and Income Verification

• Proof of Insurance/Add Loss Payee

• Loan Payoff/Payment History

• Mortgage/Rent Reference

I understand that I may see the information that is to be sent, and that I may revoke the authorization at any time by written, dated communication. I have read and understand the nature of this authorization. Customer Signature Date

Customer Signature Date

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