AUTHORIZATION FORM
Account No: ____________________
I Hereby authorize my mortgage lender, _____________________________________, to discuss my request for a Short Payoff with the individual(s) that I have identified below as my designated agent(s) (hereinafter the “Designated Agent”).
Further, BANK OF AMERICA, N.A is hereby authorized to negotiate the terms of a Short Payoff. I understand that I
will be fully responsible for reviewing any information that is sent by BANK OF AMERICA, N.A to my Designated Agent.
This Authorization will remain effective until I specifically notify Bank of America, N.A’s Workout Department in
writing that this authorization is of no force and effect.
My Designated Agents are:
Beatrice O. Salako
___________________________ Date: ______/______/ ______
(Signature)
Real Estate Broker Contact Information:
Elegance Realty, LLC
2951 Satellite Blvd, NE
Suite 234
Duluth, GA 30096
___________________________ ___________________________ Date: ______/______/ ______
Print Borrower Name Signature
___________________________ ___________________________ Date: ______/______/ ______
Print Co-Borrower Name Signature