Authorization to Disclose Information. Buyer authorizes the Buyer’s lender(s), the parties’ real estate agent(s) and closing attorney: (1) to provide this Contract to any appraiser employed by Buyer or by Xxxxx’s lender(s); and (2) to release and disclose any buyer’s closing disclosure, settlement statement and/or disbursement summary, or any information therein, to the parties to this transaction, their real estate agent(s) and Xxxxx’s lender(s). The foregoing offer is ACCEPTED by the Seller on . BROKER: House Auction Company By signing here, Xxxxxx acknowledges receipt of the xxxxxxx money as more particularly described herein.
Authorization to Disclose Information. Buyer authorizes the Buyer’s lender(s), the parties’ real estate agent(s) and closing attorney: (1) to provide this Contract to any appraiser employed by Buyer or by Xxxxx’s lender(s); and (2) to release and disclose any buyer’s closing disclosure, settlement statement and/or disbursement summary, or any information therein, to the parties to this transaction, their real estate agent(s) and Xxxxx’s lender(s).
Authorization to Disclose Information. Seller and Xxxxx authorize any closing attorney, closing agent and/or escrow company to release and disclose any seller’s and/or buyer’s closing disclosure, settlement statement and/or disbursement summary, or any information therein to the parties to this transaction, the real estate agents and Xxxxx’s lender(s). Buyer represents that it is not (and if applicable, its owners, officers, directors and employees are not) (i) included on any list maintained by the U.S. government (including the Office of Foreign Assets Control) of persons or entities with whom financial or similar transactions are prohibited; nor (ii) subject to sanctions imposed by the U.S. government. Buyer further represents that neither Buyer nor any person providing funds to Buyer (a) is under investigation for any illegal activity, or (b) had any fines or penalties assessed or had funds seized or forfeited under any anti-money laundering laws. Buyer will promptly notify Cartus in the event the representations in this Section are inaccurate, and cooperate with Cartus with respect to any resulting audits or investigations.
Authorization to Disclose Information. To Primary Care Physician If you are an insurance client, you must fill out this form. If you do not want your records released to your Primary Care Physician, check the third option below, sign and print your name. I understand that my records are protected under the applicable state law governing health care information that relates to mental health services and under the federal regulations governing Confidentiality of Alcohol and Drug Abuse patient Records 42 CRF Part 2, and cannot be disclosed without my written consent unless otherwise provided for in state or federal regulations. I also understand that I may revoke this consent at any time except to the extent that action has been taken in reliance on it. This release will automatically expire twelve months from the date signed. I, hereby authorize
Authorization to Disclose Information. Each of the undersigned individuals makes the following statement to FCM, in his or her own capacity: I/We hereby authorize FCM to disclose to the physician, clinic or storage facility named above the cryopreservation report(s), thawing instructions and results of my infectious disease testing and other medical information pertaining to the embryos. The purpose for these disclosures is to provide the Recipient with information it will need to store, thaw or otherwise handle the embryos.
Authorization to Disclose Information. You authorize us to disclose your name and address to third-parties involved with providing 911 dialing to you, including, without limitation, call routers, call centers and local emergency centers.
Authorization to Disclose Information. Buyer authorizes the Buyer’s lender(s), the parties’ real estate agent(s) and closing attorney: (1) to provide this Contract to any appraiser employed by Buyer or by Xxxxx’s lender(s); and (2) to release and disclose any buyer’s closing disclosure, settlement statement and/or disbursement summary, or any information therein, to the parties to this transaction, their real estate agent(s) and Xxxxx’s lender(s). The foregoing offer is ACCEPTED by the Seller on . By: By: Date: Date: By: By: Date: Date: BROKER: House Auction Company By signing here, Xxxxxx acknowledges receipt of the xxxxxxx money as more particularly described herein.
Authorization to Disclose Information. Buyer authorizes the Buyer’s lender(s), the parties’ real estate agent(s) and closing attorney: (1) to provide this Contract to any appraiser employed by Buyer or by Xxxxx’s lender(s); and (2) to release and disclose any buyer’s closing disclosure, settlement statement and/or disbursement summary, or any information therein, to the parties to this transaction, their real estate agent(s) and Xxxxx’s lender(s). The foregoing offer is ACCEPTED by the Seller on . PURCHASER: SELLER: . BROKER: House Auction Company By signing here, Xxxxxx acknowledges receipt of the xxxxxxx money as more particularly described herein.
Authorization to Disclose Information. The Customer acknowledges that there may be disclosure of informa- tion to third parties, whether in the Kingdom or otherwise, by the Bank and the Customer consents to such disclosure.
Authorization to Disclose Information. Seller authorizes: (1) any attorney presently or previously representing Seller to release and disclose any title insurance policy in such attorney's file to Buyer and both Xxxxx's and Seller's agents and attorneys; (2) the Property’s title insurer or its agent to release and disclose all materials in the Property's title insurer's (or title insurer's agent's) file to Buyer and both Buyer's and Seller's agents and attorneys and (3) the closing attorney to release and disclose any seller’s closing disclosure, settlement statement and/or disbursement summary, or any information therein, to the parties to this transaction, their real estate agent(s) and Xxxxx’s lender(s).
