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 . Date of Payoff of Mortgage. Please provide us with a Payoff Statement as of that date, including a per diem amount in case the payoff date is extended. Searching for a fillable Mortgage Loan Payoff Letter Template? Use our easy editor for PDF files and fill this form out quickly. Please provide payoff information for the above referenced mortgage. Also, please provide loan number and per diem interest. State-specific Mortgages or Deeds of.