MORTGAGE PAYOFF / ASSUMPTION REQUEST & AUTHORIZATION FORM
File No.:
Date:
Lender: _____________________________________________________________
Lender Address: ______________________________________________________
Loan Number: ________________________________________________________
Lender Phone: ________________________________________________________
Property Address:
Mortgagor:
Please be advised that I/We have sold the above named property as follows:
______________ New Mortgage: This Mortgage will be paid in full.
______________ Assumption Letter: Purchaser will assume the present Mortgage. Provide Status
Letter.
______________ Land Contract: Provide status letter of Mortgage and your approval of sale.
You are hereby authorized and directed to furnish Bankers Title Settlement Services, at the address and
fax listed above, the following information on my/our loan;
______________ Payoff Letter: as of the last payment received and posted, including daily interest.
______________ Assumption Letter: (Monthly payment, Interest Rate, Prepayment & Escrow
Balance)
______________ Land Contract: Approval Letter and Loan Status statement
By signing this form, Mortgagor authorizes fees associated with ordering the payoff to be
applied to their account (fax fee/payoff fee).
SIGNED:
_________________________
___________________
Last 6 of SSN
_________________________
___________________
Last 6 of SSN
To Mortgagor: Is this Mortgage an Equity Line of Credit? YES / NO
**If Yes, Mortgagor, signing above authorizes the Lender to freeze and close subject account.
Thank you,