Common use of Authorization for Release of Information Clause in Contracts

Authorization for Release of Information. DUE TO THE FDCPA, WE ARE NOT ALLOWED TO RELEASE ANY INFORMATION REGARDING YOUR ACCOUNT WITHOUT WRITTEN CONSENT. THE ONLY PERSON ALLOWED TO RECEIVE INFORMATION OR MAKE CHANGES TO ANY ACCOUNT WITH VERMILION PARISH WATERWORKS DISTRICT NO. 1, IS THE INDIVIDUAL NAMED ON ACCOUNT AS WATER USER OR LEGAL SPOUSE IF NAMED ON WATER USER AGREEMENT AS SUCH. BY SIGNING THE RELEASE FORM BELOW YOU ARE GIVING OUR OFFICE PERMISSION TO DISCUSS YOUR ACCOUNT WITH ONLY THE INDIVIDUAL OR INDIVIDUALS LISTED. THIS RELEASE FORM SHALL REMAIN IN EFFECT AS LONG AS YOUR ACCOUNT IS ACTIVE. IF AT ANY TIME YOUR ACCOUNT SHOULD BECOME INACTIVE A NEW RELEASE WILL HAVE TO BE COMPLETED FOR THE NEW ACCOUNT. IF AT ANYTIME YOU SHOULD CHOOSE TO TERMINATE OF CHANGE THIS AUTHORIZATION, WE REQUIRE WRITTEN NOTICE STATING YOUR INTENTIONS. I, __________________________________________________________________________________________________________ (FIRST) (MI) (LAST)

Authorization for Release of Information. DUE TO THE FDCPA, WE ARE NOT ALLOWED TO RELEASE ANY INFORMATION REGARDING YOUR ACCOUNT WITHOUT WRITTEN CONSENT. THE ONLY PERSON ALLOWED TO RECEIVE INFORMATION OR MAKE CHANGES TO ANY ACCOUNT WITH VERMILION PARISH WATERWORKS DISTRICT NO. 1, IS THE INDIVIDUAL NAMED ON ACCOUNT AS WATER USER OR LEGAL SPOUSE IF NAMED ON WATER USER AGREEMENT AS SUCH. BY SIGNING THE RELEASE FORM BELOW YOU ARE GIVING OUR OFFICE PERMISSION TO DISCUSS YOUR ACCOUNT WITH ONLY THE INDIVIDUAL OR INDIVIDUALS LISTED. THIS RELEASE FORM SHALL REMAIN IN EFFECT AS LONG AS YOUR ACCOUNT IS ACTIVE. IF AT ANY TIME YOUR ACCOUNT SHOULD BECOME INACTIVE A NEW RELEASE WILL HAVE TO BE COMPLETED FOR THE NEW ACCOUNT. IF AT ANYTIME YOU SHOULD CHOOSE TO TERMINATE OF CHANGE THIS AUTHORIZATION, WE REQUIRE WRITTEN NOTICE STATING YOUR INTENTIONS. I, __________________________________________________________________________________________________________ (FIRST) (MI) (LAST)) HEREBY AUTHORIZE VERMILION PARISH WATERWORKS DISTRICT NO. 1 TO DISCUSS WITH AND/OR RELEASE INFORMATION WITH REGARDS TO MY ACCOUNT AT THE FOLLOWING ADDRESS TO THE FOLLOWING:

Authorization for Release of Information. DUE TO THE FDCPA, WE ARE NOT ALLOWED TO RELEASE ANY INFORMATION REGARDING YOUR ACCOUNT WITHOUT WRITTEN CONSENT. THE ONLY PERSON ALLOWED TO RECEIVE INFORMATION OR MAKE CHANGES TO ANY ACCOUNT WITH VERMILION PARISH WATERWORKS DISTRICT NO. 1, IS THE INDIVIDUAL NAMED ON ACCOUNT AS WATER USER OR LEGAL SPOUSE IF NAMED ON WATER USER AGREEMENT AS SUCH. BY SIGNING THE RELEASE FORM BELOW YOU ARE GIVING OUR OFFICE PERMISSION TO DISCUSS YOUR ACCOUNT WITH ONLY THE INDIVIDUAL OR INDIVIDUALS LISTED. THIS RELEASE FORM SHALL REMAIN IN EFFECT AS LONG AS YOUR ACCOUNT IS ACTIVE. IF AT ANY TIME YOUR ACCOUNT SHOULD BECOME INACTIVE A NEW RELEASE WILL HAVE TO BE COMPLETED FOR THE NEW ACCOUNT. IF AT ANYTIME YOU SHOULD CHOOSE TO TERMINATE OF CHANGE THIS AUTHORIZATION, WE REQUIRE WRITTEN NOTICE STATING YOUR INTENTIONS. I, __________________________________________________________________________________________________________ (FIRST) (MI) (LAST)