Third Party Payoff Request Form v2

Fay Servicing, LLC will only release a mortgage payoff statement to the borrower(s) or a person acting on the borrower's behalf with the written authorization.

1. Contact Information

Contact Name

Company / Organization

Contact Email

2. Borrower Information

Loan Number

SSN

Borrower First Name

Borrower Last Name

Property Street Address

Property City

Property State

Property Zip Code

Mailing Street Address

Mailing City

Mailing State

Mailing Zip Code

3. What type of payoff are you requesting?

Payoff Type

4. How would you like to receive your payoff request?

Delivery Type

5. Enter your [email address] or [fax number] or [mailing address]

Delivery Email

Delivery Fax

Delivery Street Address

Delivery City

Delivery State

Delivery Zip Code

6. Enter the Effective Payoff Date (max. 30 days from current date)

Payoff Effective Date

7. Third Party Authorization for Payoff Request

TPA on File

NoYes

8. Acknowledgement of Payoff Request Service Level Agreement (SLA)

SLA Acknowledgement

NoYes

9. Certification of Payoff Request and Digital Signature

Signature

Signature Date

Attach a file

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