CLIENT INFORMATION-SHARING AUTHORIZATION
Client Name
*
First Name
Last Name
Client Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Client 2 Name (required if applicable)
First Name
Last Name
Client 2 Email (if applicable)
example@example.com
Client 2 Phone Number (if applicable)
-
Area Code
Phone Number
Advisor #1 Name
*
First Name
Last Name
Advisor #1 Email
*
example@example.com
Advisor #1 Phone
*
-
Area Code
Phone Number
Advisor #2 Name
*
First Name
Last Name
Advisor #2 Email
*
example@example.com
Advisor #2 Phone
*
-
Area Code
Phone Number
Advisor #3 (required if applicable)
First Name
Last Name
Advisor #3 (required if applicable)
example@example.com
Advisor #3 Phone (required if applicable)
-
Area Code
Phone Number
Advisor #4 (required if applicable)
First Name
Last Name
Advisor #4 (required if applicable)
example@example.com
Advisor #4 Phone (required if applicable)
-
Area Code
Phone Number
Advisor #5 (required if applicable)
First Name
Last Name
Advisor #5 (required if applicable)l
example@example.com
Advisor #5 Phone (required if applicable)
-
Area Code
Phone Number
By signing below, I/we (the client) authorize the parties noted above to securely share/exchange the following personal and confidential information and documentation as well as collaborate on potential advice and guidance:
*
All relevant information available or requested by the party
All relevant documentation available or requested by the party
Only the information or documents listed below:
(please specify information or documents)
I/We understand that this authorization shall remain in effect
*
until I choose to revoke it, in writing, which I may do at any time.
for 1 year following this form being executed, unless I choose to revoke it in writing sooner.
for 2 years following this form being executed, unless I choose to revoke it in writing sooner
Other
*
I/We further understand that this does not constitute a Power Of Attorney (POA) in any form.
Today's Date
*
-
Month
-
Day
Year
Date
Client 1 Signature
*
Client 2 Signature (required if applicable)
Continue
Continue
Should be Empty: