Edit, sign, and share sample payoff letter for private mortgage online. No need to install software, just go to DocHub, and sign up instantly and for free.A payoff statement should include the name and address of the lender preparing the statement and be addressed to the lender that requested the payoff. This form is furnished to give you a statement of actual settlement costs. Do you need a loan payoff request form? How to fill out the Mortgage Payoff Statement Request Form? A copy of the payoff statement for the first mortgage. Verification of funds letters come in a few different forms, with the most common being bank statements. Form Preview Example ; Interest.