Key Easy Transfer Kit Credit Payoff Form
Date: Please use the enclosed funds to payoff: (Check One) Account Number: ❏ loan ❏ line of credit ❏ credit card
ACCOUNT INFORMATION: Payoff Amount: Date of Payoff:
X Customer Signature Printed Name X Customer Signature (joint signer) Printed Name
Date
Date
Please send receipt of account closure to me at the following address: Name: Address: Social Security Number: Phone Number: Alternative Phone Number: