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What is your relationship to this loan?: *

What is the reason for this payoff request?: *

Payoff request information:

Name of AFG Borrower: *

Property Address: *

Property Address:

City

State/Province

Zip/Postal

Assessor / Tax parcel No *

AFG loan No:

Proposed payoff date *

Contact information for person requesting the payoff:

Your Name: *

Company name: *

Your position at the company and relationship to this loan *

Direct telephone contact number: *

Email address:

Name: *

Email *

Phone *

Mailing address *

Mailing address

City

State/Province

Zip/Postal

Investment property address *

Investment property address

City

State/Province

Zip/Postal

APN

Vesting name *

Estimated Retail Value

Purchase price

Requested Loan Amount *

Estimated repair cost

Is the property under contract

Yes

Proposed funding date

Title Company:

Title Company Phone Number:

Name: *

Email *

Phone *

Mailing address *

Mailing address

City

State/Province

Zip/Postal

Investment property address *

Investment property address

City

State/Province

Zip/Postal

APN *

Vesting name *

Estimated Retail Value *

Purchase price *

Requested Loan Amount *

Estimated repair cost *

Is the property under contract *

Yes

Proposed funding date *

Title Company:

Title Company Phone Number:

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Payoff request information:

Contact information for person requesting the payoff: