Payoff Lender Name: __________ Today’s Date:______ Loan Number: ____________________________________________________ Borrower (s) Name(s):__________________________________
Property Address:______________________________________

I (we), the undersigned and borrower(s) on the above-referenced loan, do authorize [__ ] to provide a payoff statement regarding the above-referenced loan to Biltmore Title, LLC, the authorized party, including but not limited to, payoff amounts and information on escrow disbursements for the purpose of completing my/our transaction. This authorization is valid for 90 days from the date above.

Sign Here:_____________________________________________
Borrower #1/Print Name Here:___________________________
Social Security No: XXX-XX-_ (Only provide last 4 digits)

Sign Here:_________________________________________________ Borrower #2/Print Name Here:___________________________
Social Security No: XXX-XX-__ (Only provide last 4 digits)

Please note that Biltmore Title, LLC is handling the title and settlement services on the property listed above. As part of the settlement process, we must obtain payoff information on current liens against this property. Please complete this form in its entirety and return via fax to 615-907-1538. Please DO NOT email confidential information

2909 Old Fort Parkway Ste 106 Murfreesboro, TN 37128 Phone 615-907-3289/ Fax 615-907-1538

Where business is “Biltmore” on relationships with Title Professionals.