Payoff Request Form

This is an easy-to-fill payoff request form.

Questions for Payoff Request Form

1.

Borrower Name 

The answer should be a text input.
2.

Loan Number 

The answer should be a text input.
3.

Property Address

The answer should be a text input.
4.

Street Address

The answer should be a text input.
5.

City

The answer should be a text input.
6.

State / Province

The answer should be a text input.
7.

Postal / Zip Code

The answer should be a number input.
8.

Please make my payoff valid through (Payoff quotes good for maximum of 30 days) 

The answer should be a date input.
9.

Reason for Payoff Request 

The answer should be a single choice:
  1. Sale of Property
  2. Refinance Inquiry
  3. Divorce
  4. Death
  5. Others
10.

Requestor Name 

The answer should be a text input.
11.

Requestor Email Address 

The answer should be a email input.
12.

Requestor Company

The answer should be a text input.
13.

Requestor Company Address

The answer should be a text input.
14.

City

The answer should be a text input.
15.

State / Province

The answer should be a single choice:
    16.

    Postal / Zip Code

    The answer should be a text input.
    17.

    How do you want the payoff delivered

    The answer should be a single choice:
    1. Email
    2. Fax
    3. Mailed

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