Sample Disclosure Statement On mmentary Loan. A Payoff Request Form is an essential document for those looking to fulfill the remaining balance on a home equity line of credit.A Payoff Request Form is an essential document for those looking to fulfill the remaining balance on a home equity line of credit. Cash or credit cards are not accepted. You'll need to complete the Early Remittance Request form. The Dime Bank, the best community banking in Pennsylvania with branches in Honesdale, Hawley, Damascus, Greentown, Dingmans Ferry, Lake Region, Carbondale. Welcome to the Tax Claim Office. Credit card payments are not permitted. To pay a benefit, property damage, or other invoice, please fill out the form below or mail a check or money order to the following address. Fill in the details we ask for on the bottom of your statement.