Client Authorisation Form

Emmanuel Methodist United Reform Church,
38 Derby Street,
Ormskirk,
L39 2DE

To whom it may concern

Authorisation

West Lancashire Debt Advice is assisting me with my financial affairs and I hereby authorise you to divulge details of my financial situation to any official adviser from West Lancashire Debt Advice and to negotiate with them accordingly.
Client name *
Your Name
Client Address *
Your House Number, Street and Town
Post Code *
Your Post Code
Signed *

Clear
Date *

Day Month Year
Date of signing
Copy to be retained by the client

Authorised and regulated by the Financial Conduct Authority. Working in association with Community Money Advice.
The Queen's Diamond Jubilee Volunteering Award 2012
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