You may complete and print this form to provide your current mortgage payoff authorization to our office. Fax the complete for to (978) 383-5511, or mail it to the address below.

Mortgage Payoff Authorization Form

Your Information (*required field)

Your Name*

Property Address *

City*, State*, Zip

Your Social Secruty #*:

Sale Refinance

First Mortgage

Lender Name *

Loan/Account # *

Lender Telephone

Equity/Second Mortgage

Lender Name

Loan/Account #

Lender Telephone

To the Lender

Please consider this a formal request for a payoff figure relating to the above referenced loan. The payoff figure should be good through ____________. I understand that there may be a fee for this service. If the loan is a line of credit that will be closed, please freeze the account; I understand that no further advances will be honored, and that the account will be closed. Please provide the payoff information via fax directly to:

_____________________________________
Signature

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David R. Rocheford, Jr.
Attorney at Law
100 Erdman Way, Suite 101
Leominster, MA 01453
Fax: (978) 383-5511
Tel: (978) 847-0104