A payoff agreement is an informal contract in which a creditor agrees to accept the balance of a debt owed as full payment. Payoff Statement Form.Mortgage Servicing, July 27, 2021 ; Mortgage Company: Required Disclosure – Specific Notice to Mortgage Applicant (7 TAC §56.200(b)). We will provide a payoff statement and accept payment on the account. Complete our Mortgage service or holder of the lien on a property form to receive a copy. 7861. Where do I send my proof of insurance coverage? BSI Financial Services Insurance Department PO Box 790088. Most courts have a form called the "Statement of Inability to Pay" that you can fill out to show your financial situation. Tax season is coming! Most courts have a form called the "Statement of Inability to Pay" that you can fill out to show your financial situation.