By including a per diem amount in the letter, the parties will not have to execute another payoff letter if the termination date. Please accept this as my authorization to issue a payoff statement to.Through an effective date of . A payoff agreement is an informal contract in which a creditor agrees to accept the balance of a debt owed as full payment. Searching for a fillable Mortgage Loan Payoff Letter Template? Use our easy editor for PDF files and fill this form out quickly. Date of Payoff of Mortgage. Please provide us with a Payoff Statement as of that date, including a per diem amount in case the payoff date is extended.