Third-Party Authorization Form

I/We authorize Time Investment Corporation T/A Time Financing Service ® (hereinafter “Time Financing Service ®”), to communicate information regarding my loan to any or all of the designated third parties listed below. Time Financing Service ® is expressly authorized to communicate any and all information about my loan or contract with Time Financing Service ® which may include account/loan information about collateral, payment status, payment amount, account balance, account payoff, any late fees or other charges owing on the account, and any amount necessary to either keep the account current or bring it current if it is past due or otherwise in default. I am granting this authorization to you and designating the person or persons below pursuant to the provisions of N.C.G.S. Section 75-53 (1) (a).

I agree to hold Time Financing Service ®, its employees, officers, and agents harmless from any claims based upon the above authorization, and release any claims against said parties for any claims I might otherwise assert pursuant to any state or federal law or regulation concerning the dissemination of any information regarding my debt to a third party by executing this authorization.

By submitting this form I/we agree to the information above.