Seller Information and Mortgage

Payoff Request Form

Property Address To Be Sold
Nare
Social Security
Male Female
008
Single Married
Divorce Pending
Widowed
Cell Phone
Home Phone
Ensal
Address if different)
Mortgage Information
kw KELLERWILLIAMS
Seller 2 (Print name as it
appears on T Marmo
Social Security
Male
Fersale 008
Single Married
Divorce Pending
Widowed
Cell Phone
Home Phone
Email
Address diferent
State
City
State
Zip.
City
1 Mortgage lender,
Phone
Laan Muniber
Cument balance
2 Mortgage or Home Equity
Lander
Phone
Emall
Loan Muniber
Carrent balance
Attorney Information
seller represented by anatomy?
No
Yes
If yes, Attorney's Name
Phone
Condo or Homeo's Association
Addre
Phone
Seller would like the color of the
transaction by the use of
electroitures
Emoll
Contact Person
State
Zip.
Signature
Seller hereby confirms the
accuracy of the above
information and authorised to
obtain mortgage, judgment,lien
and/or municipality Information
relating to the property, including
but not peyoff amounts
and escrow information.
Date
Seller Two Signature
Dute