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