Payoff Request Form. First name, Last name, Account Number (optional), Phone, Street address, Apartment, suite, etc.DRAFTING NOTE: COLLATERAL​​ credit or for costs and expenses. Please fill out the form below or see additional contact information below this form. Fill out the form below to request a loan payoff letter. If you have any questions, please contact Loan Customer Service at 1-800-677-6272 option 5, option 2. All of the permits listed below are available online. You can complete and submit your application and payment online using the New York State License Center. This assignment is made and the Policy is to be held as collateral security for any and all liabilities of the undersigned, or any of them, to the Assignee,.