Payoff Authorization Form

Buyer/Lessee Information
Date MM slash DD slash YYYY
Buyer/Lessee Name*
Buyer/Lessee Address*
Email*
Co-Buyer/Co-Lessee Information
Co-Buyer/Co-Lessee Name
Co-Buyer/Co-Lessee Address
Trade In Vehicle Description
Year
Make
Model*
Mileage
Vehicle Identification Number, if any
What Dealership are you working with?*
- Wexford
- Harmarville
- South (West Mifflin)
- Wheeling
Name of Your Salesperson
Signee Information
In this Authorization to Release Payoff Information • “I, “me”, and “my” means either Buyer/Lessee, • “you” means the Seller/Lessor, and; • “Trade-In” means either a trade-in vehicle or trade-in vehicles. I have agreed to trade in the vehicle(s) described above. Because my Trade-In may have an outstanding lien(s) against it (or them) with a financial institution I am granting you the right to contact the Lienholder(s) on my behalf for the purpose of confirming the amount owed on the Trade-In and to obtain other related information. These terms are incorporated by reference into and made part of the documents used with this transaction including, if applicable, the Retail Buyer’s Order, Lease Order, Retail Installment Sales Contract or Lease Contract
Date MM slash DD slash YYYY
Buyer/Lessee Name
Co-Buyer/Co-Lessee Name
Phone
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Buyer/Lessee Information