Fillable Authorization for Loan Payoff & Title Request (Inspirus Credit Union)

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Authorization for Loan Payoff & Title Request (Inspirus Credit Union)

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A DIVISION OF GesCJ CREDIT UNION
□ □
Authorization for Loan Payoff & Title Request
Current registered owners, please complete all requested information below and send by mail to Inspirus
Credit Union, P.O. Box 576, Seattle, WA 98111 or fax to 206.676.1032.
Vehicle Information:
Year/Make/Model
VIN/Serial Number
Vehicle Mileage
Payoff Information where loan is currently financed:
Name of Institution
Loan Account Number
I authorize the acceptance of the enclosed payoff for the loan referenced above
X
X
Signature of Current Registered Owner
Printed Name of Current Registered Owner
X
X
Printed Name of Current Registered Owner
INSTRUCTIONS FOR FINANCIAL INSTITUTION:
PLEASE SEND THE TITLE ALONG WITH A COPY OF THIS AUTHORIZATION TO
Inspirus Credit Union
Our Borrower(s):
Po Box 576
Address:
Seattle, WA 98111-0576
I (we) hereby authorize you to accept from Inspirus Credit Union, a Division of Gesa Credit Union the payoff
balance of my (our) loan/lease. You are further authorized and instructed to surrender to the Credit Union or
the borrower listed above, the documents of title, properly endorsed and released pursuant to RCW
46.12.675. Your failure to do so may make you liable for $100.00 plus any loss caused by your failure
to do so under Washington State law. For leases, a bill of sale showing sale price, sales tax collected, and
an odometer disclosure statement must accompany the title.
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Authorization for Loan Payoff & Title Request (Inspirus Credit Union)

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Completed 5 March 2021

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