Pay Off Form

Date (mm/dd/yyyy)

Mortgage Company

Phone

Fax

Customer Name(s)

Property Address

1) Lender Name

1) Lender Number

2) Lender Name

2) Lender Number

You are authorized to release payoff information (including updates) on my loan(s) listed above to Virginia Home Title & Settlements.

Their phone number is

Their fax number is

Contact person is

If your company charges a fee for faxes, this letter is both acceptance and authorization of said fax fee.

For Lines of Credit, please freeze the loan amount to include only obligations incurred or draws I have made prior to and including the date of this letter. I agree to cease signing all checks and/or credit cards and/or drafts.

This is also a notice that I intend to sell or execute a new mortgage on the property. Under the laws of some States, future advances may be subordinate to the rights of a new lender or buyer.

Electronic Signature

Electronic Signature 2 (if necessary)

My contact number

Cell

Please select the office that should receive the authorization.

*** By electronically signing this form, you are agreeing to the terms and conditions set forth by Virginia Home Title & Settlements. ***

YOU WILL RECEIVE CONFIRMATION OF RECEIPT WITHIN 24 HOURS DURING BUSINESS HOURS MONDAY THROUGH FRIDAY (EXCEPT HOLIDAYS).