Common Contracts
1 similar Account Access Agreement contracts
Account Access Agreement: Consent for Use and Disclosure of Financial, Banking, Payment and Insurance InformationAccount Access Agreement • April 18th, 2019
Purpose of Consent: By signing this form, you will consent to our use and disclosure of your protected financial, banking, payment and insurance information to carry out payment activities, creditor negotiation and resolution and insurance coverage determination. A document explaining the use of the Health Information Portability and Accountability Act is available for your use. This consent is given to At Home FinanceCare, LLC., and its duly authorized agents. This may include access to your bank accounts user names and passwords.
