Payoff Request Authorization

(IF YOU HAVE A MORTGAGE, PLEASE COMPLETE THIS FORM, IF NOT PLEASE DISREGARD)

The undersigned borrower hereby authorizes Harper Title Company, LLC to request a PAYOFF STATEMENT and any additional information that may be needed to pay off the following mortgage loan:

Lender: please fax a payoff statement (valid thirty days (30) days) from the date of this executed authorization. Please send to or info@harpertitlecompany.com.

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