A secured lender shall prepare and deliver a payoff demand statement to the person who has requested it within fourteen days after receipt of the demand. A payoff statement or a mortgage payoff letter will typically show the balance you must pay in order to close your loan.This form is furnished to give you a statement of actual settlement costs. Mailing Closing Statement. A lender's payoff statement or letter will show the amount you need to pay to completely close out the loan. If you need a template, click here to download borrower authorization template. 20 MB max file size. How to fill out the Payoff Request Letter Templates? 1. Enter your personal information and amount owed. 2. Do you need a loan payoff request form?