Here is a link to the Bank of America Third

Party Authorization form.



(Working with a third party)

Account No.: ______________________

I hereby authorize Bank of America, N.A. to discuss my request for payment assistance with the individual(s) that
I have identified below as my designated agent(s) (hereinafter the “Designated Agent”). Further, Bank of
America, N.A. is hereby authorized to negotiate the terms of a mortgage assistance agreement with my
Designated Agent and to deliver documents to my Designated Agent that concern my request for payment
assistance. I understand that I will be fully responsible for reviewing any information that is sent by Bank of
America, N.A. to my Designated Agent. This Authorization will remain effective until I specifically notify Bank of
America, N.A.’s Home Retention Division in writing that this Authorization is of no further force and effect.

My Designated Agents are:

(Insert name of Designated Agent) (Insert contact number)

(Insert name of Designated Agent) (Insert contact number)

(Insert name of Designated Agent) (Insert contact number)

Borrower: _______________________________ Date: _________________

Co-Borrower: _______________________________ Date: _______

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