Vehicle Refinance Form - Unitus Community Credit Union

P.O. Box 1937 Portland, OR 97207-1937

Vehicle Refinance Form

Account Number: Notice Date:

Part A: Authorization for Payoff / Security Interest Acknowledgement

By negotiating or taking proceeds of this check, payee agrees to release its lien in the described collateral and to forward the title certificate within 10 days from receipt of this check to UNITUS COMMUNITY CREDIT UNION. Payee assigns payee(s) security interest to the Credit Union until the title certificate has been processed. I hereby authorize Unitus Community Credit Union to payoff, receive the title and/or equivalent documents, and receive any verbal or written information relating to my account, for the following vehicle:

Year

Make

Model

VIN #

Odometer reading

Financial Institution

Phone Number

Account Number

PLEASE MAIL TITLE TO:

Unitus Community Credit Union Attn: Consumer Lending/Titles PO Box 1937 Portland, OR 97207-1937

With this payoff, the undersigned hereby grants a security interest to Unitus Community Credit Union in the above-described vehicle, and agrees to the terms of the Security Agreements (Fixed Rate Loan Disclosure, Promissory Note, and Security Agreement). The undersigned also agrees to provide full comprehensive and collision insurance with a maximum deductible of $1,250.00. You must contact your insurance company and have Unitus Community Credit Union listed as the Loss Payee.

Insurance Co.

Agent Name

Phone #

Policy #

Borrower Signature

Date

Borrower Signature

Date

Part B: Other Owner Acknowledgement

An Other Owner is a person whose name is on the title to the vehicle but does not have to pay the debt evidenced by the Security Agreements. The Other Owner hereby grants a security interest in the above-described vehicle to Unitus Community Credit Union to secure payments of all amounts owed under the Security Agreements, and agrees to all the terms stated in the Security Agreements, except that the Other Owner will not be personally liable for the amounts owed to Unitus Community Credit Union under the Security Agreements.

Other Owner Signature

Date

Drivers License #

State

Date of Birth

Part C: Special Power of Attorney

I/We,

hereby authorize Unitus Community Credit

Union to act as my/our representative, and to sign my/our name(s) to any forms necessary for a transfer of my right, title, and interest in the

following vehicle:

Year

Make

Model

VIN #

Borrower Signature

Date

Driver License # and State

Date of Birth

Borrower Signature

Date

Signatures must be notarized for all states except Oregon

State of :

County of:

Acknowledged before me this

day of

Notary Signature:

Commission Expiration Date:

, 20

Driver License # and State

Date of Birth

Right of Survivorship (Optional; Check here if desired)

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