Payoff Request Form. First name, Last name, Account Number (optional), Phone, Street address, Apartment, suite, etc.A mortgage payoff letter can come in two forms. One form tells borrowers the remaining principal amount and interest they have to pay to close out the loan. Please accept this as my authorization to issue a payoff statement to. Through an effective date of . Arrange for payoff of loans. The seller should advise its bank of the projected closing date and request a pay-off letter. Arrange for payoff of loans. The seller should advise its bank of the projected closing date and request a pay-off letter.