Authorization to Release Payoff Information
Borrower 1
First Name
Last Name
Borrower 2 (If Applicable)
First Name
Last Name
Last 5 Digits of Social Security Number (SSN) - Borrower 1
*
Last 5 Digits of Social Security Number (SSN) - Borrower 2
Property Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Lender's Name:
Account | Loan Number:
Lender's Phone Number:
Type of Loan:
First Mortgage
Second Mortgage
Third Mortgage
Equity Line
Signature of Borrower 1
Signature of Borrower 2
The undersigned hereby authorizes the above named Lender to release Kham Law, LLC and any of its employees acting on its behalf any and all payoff information associated with the loan account referenced above. Please furnish any and all pertinent payoff information to Kham Law, LLC as they may require. If this account allows for advances of a credit line, the undersigned requests and authorizes the Lender to block this account against all future draws. If the Lender makes additional advances, they will not be secured by the above referenced Property. Upon issuance if a payoff statement and receipt of payment based upon that statement, Lender will be obligated to release the Security Instrument securing the line of credit.
*
I agree
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit (Secured)
Should be Empty: