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Authorization To Release Confidential Information
AUTHORIZATION TO RELEASE CONFIDENTIAL INFORMATION
[Date]
[Mr/Mrs/Ms/Dr] [First Name of receipient] [Last Name of receipient]
[Title of receipient]
[Company of receipient]
[Address of receipient]
[City of receipient], [State of recipient] [Zip Code of receipient]
Dear [Mr/Mrs/Ms/Dr] [Last Name of recipient]:
You are hereby authorized and requested to mail or deliver to:
Name [Name of authorized person]
Address [Address of authorized person]
Either original or copies of the below described documents or confidential information that you may have in your possession. You may bill me for any costs associated with your compliance with this request and I thank you for your cooperation.
Very truly,
Signature Print Name
Address