Sample Forms, Policies, and Contracts. Sample Form of Payoff Letter.Do you need a loan payoff request form? This is an example of a payoff letter used in a syndicated loan transaction. This payoff letter (including the defined terms such as Lenders,. This hypothetical example is used for illustrative purposes only. Actual results will vary. A copy of the Good Faith Estimate or estimated settlement statement from the lender. Payoff good thru date. 504. Payoff of first mortgage loan. 103.