Use the button above to print the Authorization Release Form. Please fax the form to 1(800)211-8000 at your earliest convenience.
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Client Authorization To Release Financial Information
Debt Solvency Group, Inc.
P.O. Box 1117
Columbia, MD 20145
Client Name: _______________________________ (please print)
I hereby authorize any employee or agent of Debt Solvency Group, Inc. to release and/or discuss any and all financial information contained in or pertaining to any accounts included with any financial institution holding or owning my account(s) on my behalf.
Date: ____________________
Print Name: ________________________________
Signature: _________________________________
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