[NoteSmith user: This information comes from IRS publications and is designed for IRS forms such as 1098 and 1099-INT. The IRS requires that a signed paper copy of consent first must be received. Remove this top bracketed paragraph before using this text and substitute your name in the Contact Name line below. You may modify the text but do not remove the paragraph titles. Check with a local, knowledgeable attorney concerning the emailing of other statements such as payoffs or late letters.]

In an effort to provide you with required documentation concerning your note as quickly as possible, we would like to email the information instead of using postal mail. Please read over the following consent form and, if you agree that email would be simpler, sign and return the form to us.

Consent: If you do not consent to receive the statement electronically, a paper copy will be mailed and you do not need to return this form to us.

Scope and duration of consent: This consent applies to all statements we would ordinarily mail, starting with the next statement after you grant consent until termination (see below). 

Obtaining a paper copy: You can obtain a paper copy of your documentation by withdrawing your consent and requesting a paper copy of the last electronic statement you received or were due to receive.

Withdrawing your consent: Consent to receive statements electronically may be withdrawn at any time by furnishing the withdrawal in writing (electronically or on paper) to the person whose name appears on the last electronic statement you receive. Confirmation of the withdrawal also will be in writing (electronically or on paper).

Termination: Statements will no longer be furnished electronically either upon you withdrawing your consent or when your note is paid off in full.
 
Update contact information: You may contact us (electronically or on paper) at any time to change the email address where you want your electronic statements sent.
 
Hardware and software: You will need the following to receive electronic documentation: A computer capable of receiving email attachments, version 8 or newer of the free Adobe Reader available at www.Adobe.com, and a printer attached to your computer if you want to print the documentation. The file we send will be a Portable Document Format (PDF) file.

I hope you will provide your consent to save time and paper by receiving your statements from us electronically. Please sign below and return this document to us by postal mail or in person. We must receive a paper copy of this form.

Sincerely,

[Company Contact Name Here]


I consent to receiving statements by email.

Signed: __________________________________

Print name: ______________________________

Dated: ___________________________________