By including a per diem amount in the letter, the parties will not have to execute another payoff letter if the termination date. Please accept this as my authorization to issue a payoff statement to.Through an effective date of . {This is an Adjustable Rate Mortgage. A payoff agreement is an informal contract in which a creditor agrees to accept the balance of a debt owed as full payment. Please provide payoff information for the above referenced mortgage. Also, please provide loan number and per diem interest. Use our library of forms to quickly fill and sign your TREC contracts online. Figure: 7 TAC §155.2(c)(6) PAYOFF STATEMENT FORM And receiving reimbursement for your actual per diem costs up to the locality rate for the OCONUS location.