Date:

Lender:   ________________________
Phone:   _________________________
Fax:    _________________________

Re: __________________________________________
            Loan#: ____________________

Attn: Loss Mitigation Department

I hereby authorize ____________________(lender) to discuss my request for payment assistance with the individuals that I have identified below as my designated agents (hereinafter the Designated Agent). Further, ________________________ (lender) is hereby authorized to negotiate the terms of a workout agreement with my designated Agent and to deliver documents to my Designated Agent which concerns my request for payment assistance. I understand that I will be fully responsible for reviewing any information that is sent to my Designated Agent.
This authorization will remain in effect until I specifically notify
_______________________________ (lender) Loss Mitigation Department in writing that it is no longer of force and/or effect.

My Designated Agent is:

Wendy Lockhart
Sarah Noreikas
Keller Williams Realty Gulf Coast
office: 727-456-4771
cell: 727-543-3653
fax: 727-367-6170

Sincerely,