AUTHORIZATION TO MAIL FUNDS TO

ALTERNATE/TEMPORARY ADDRESS

This form is optional—Complete and include this form with your check if you would like the funds sent to an address other than the one we have on file for you. This form is not required to receive your funds.

Loan number:

Name(s) of customer(s):

Property address:

Please check the appropriate box.

I/We would like the funds mailed to me/us at an address different than the one on file.

The desired mailing address is:

Address:

I/We would like the funds mailed directly to a contractor or another third party, such as public adjuster, attorney, etc.

The name and address of the third party to whom checks should be sent is:

Name:

Address:

Signature(s) of Customer(s)

Date:

NOTE: Only one customer's signature is required, but if possible, please provide all customers' signatures.

Once you’ve completed this form, you can scan and upload it to InsuranceClaimCheck.com/Chase, a secure, Chase-approved site. You can also return it to us by mail or fax to:

Regular Mail:

Overnight mail:

Fax:

(Free of charge from

any Chase branch)