Please accept this as my authorization to issue a payoff statement to. Through an effective date of .Please list all addresses associated with the mortgage. If additional space is needed, please attach table in similar form to request. A mortgage payoff letter can come in two forms. One form tells borrowers the remaining principal amount and interest they have to pay to close out the loan. In order to process your homeowner mortgage servicing request, you must submit the following: Mortgage Servicing Request Form, Mortgage Servicing Fee. A payoff letter shows the remaining balance on your mortgage, including fees, interest, etc. Learn more about what a payoff quote is and how to request one. Mortgage (a sample request letter appears at the end of this article). 3.