PAYOFF REQUEST FORM



TO PAYOFF LENDER:

(lender’s name)
(lender’s phone number)
(lender’s address - if available)
RE: Account #    

You are hereby authorized to release payoff information regarding the referenced loan to Friendship Title, Inc.
 
 

X _____________________________  X ______________________________
NAME:  NAME: 
SSN:     SSN:    
DATE:   DATE:  

Fax completed form to:
Friendship Title, Inc.
301-951-4436

This form may be reproduced if more than one payoff statement is required.