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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