Credit Concepts, Inc.

[Pages:1]AUTHORIZATION FOR PAYOFF

Acct # ______-_______________ Date: ______________________

To: Credit Concepts, Inc. ___________________________________ ___________________________________

I hereby authorize you to accept from:

Name: _________________________________________________ Address: _______________________________________________

_______________________________________________

$ ______________.____, being the balance due on my account and you are instructed upon receipt of the above amount to surrender the Documents of Title, properly endorsed and released, to the above address.

On My (our) ________________

(Make of Vehicle)

_______________________________

(Motor/Serial number)

Signed _____________________________

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download