Please accept this as my authorization to issue a payoff statement to. Through an effective date of .Use a free Mortgage Payoff Statement Request Form to gather information from the holder of a mortgage to create an official payoff statement. 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. Creating a payoff letter is essential to any loan or mortgage repayment process. Our free templates and this guide can help you get started. All third-party payoff requests require prior authorization. Using the adjacent form you can select from two options. Create a Loan Payoff Letter online and download it as a PDF or Word document.