If your loan is with Bank Midwest located in Minnesota, Iowa or South Dakota, use our online form for a convenient way to request your loan payoff amount. This form is furnished to give you a statement of actual settlement costs.Edit, sign, and share payoff form online. No need to install software, just go to DocHub, and sign up instantly and for free. Do you need a loan payoff request form? A lender's payoff statement or letter will show the amount you need to pay to completely close out the loan. POST-CLOSING ESCROWS. Complete and submit a payoff worksheet at least 30 days prior to the anticipated payoff date. Include a completed Request for Action (RFA) form. Privacy Opt Out Form.