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Micro Title Order No:

Property Address:

Micro Title Hill County, LLC is hereby authorized to obtain payoffs from the lenders presently holding loan(s) on our property as follows:

Lender Name:

Phone No:

Address:

Loan No.:

Lender Name:

Phone No:

Address:

Loan No.:

Additional Property Information:

Homeowner’s Association Name:

Contact Person for HOA:

HOA Phone No.:

Fax:

Attn: Payoff Department(s):
I/we the undersigned hereby authorize the above referenced Lender(s) to release information to Micro Title Hill County, LLC as requested for payoff/assumption. I/we agree to pay any fees incurred/charged by you for issuance of the statement requested and/or “fax” fee(s) incurred.

Upon receipt of this authorization you are irrevocably instructed to immediately "block" and "freeze" said account(s) from future advances. All checks or charges made prior to "blocking" and/or "freezing" will be honored and posted to the account.

Upon receipt of payment in full of the amounts due per your payoff/demand statement, you are hereby authorized and instructed to close and cancel my/our account, to surrender the original security instruments and release documents along with the release/recording/reconveyance fees collected by you to Micro Title Hill County, LLC at the address set forth above. Facsimiles of this document shall be considered an acceptable original.
Date (mm/dd/yy):

Signatures: (By typing my/our name(s) below and clicking “send”, I/we hereby agree to release said information above to Micro Title Hill County, LLC)

Name:

Social Security No:

Home Phone:

Cell Phone:

Name:

Social Security No:

Home Phone:

Cell Phone:

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