Payoff Request Form. First name, Last name, Account Number (optional), Phone, Street address, Apartment, suite, etc.Arrange for payoff of loans. The seller should advise its bank of the projected closing date and request a pay-off letter. The first step is to get in touch with your lender or loan servicer. You can find their contact information on your monthly statements. Include your case number, the date of the payoff and your email address in your request. We will email the payoff statement to you upon receiving your request. Most forms may be filled out on your computer, printed and submitted for filing with the Department of State. Include your case number, the date of the payoff and your email address in your request.