Of Credit Payoff

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					                          Key Easy Transfer Kit
                          Credit Payoff Form
Date:


Please use the enclosed funds to payoff: (Check One)    ❏ loan    ❏ line of credit   ❏ credit card

Account Number:



ACCOUNT INFORMATION:

Payoff Amount:                                                Date of Payoff:




X
Customer Signature                                                          Date


Printed Name

X
Customer Signature (joint signer)                                           Date


Printed Name




Please send receipt of account closure to me at the following address:

Name:                                                         Social Security Number:

Address:                                                      Phone Number:
                                                              Alternative Phone Number:

				
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posted:6/29/2009
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