CONSENT AND AUTHORIZATION TO ACCESS FINANCIAL RECORDS
I __________________________________(Client’s name) of Social Security Number ____________________ and of ____________________________address; the Client herein, do hereby authorize ___________________________________the Financial Coach herein to access my financial records through the Savings Jar’s company website.
Any information already released may be used as stated on the consent. I understand that the Financial Coach herein needs the financial records to render their financial coaching services to me, and access to my financial records will be only for that purpose.
I understand that I can revoke this consent in writing at any time.
This consent is valid only until: _______________date.
This consent is not automatically renewable, and it expires automatically at the end of the period specified unless revoked in writing sooner. By my signature below, I affirm that I have read this release or it has been read to me, and I understand its content.
Client’s Signature __________________________________ Date _______________________
Consent Witnessed By:
Witness Signature _________________________________ Date_________________________
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