Your Name: (required)

Your Email (required)

Subject

To:

Date:

Payoff To:

Account #:

I/We hereby authorize you to release any payoff information on my/our mortgage loan, installment loan, equity line of credit loan and/or any liens to American Title Services.

Your prompt reply will help in the timely processing of my/our real estate transaction.

Thank you for your time and cooperation

Customer Signature 1

Social Security 1

Customer Signature 2

Social Security 2

* A copy of this authorization may be deemed to be the same as original.
Agreed by Customer