Financial Payoff Document

FINANCIAL PAYOFF DOCUMENT

Payor Name:    Payee Name:    Agreement Date:

RECITALS

WHEREAS, Payor executed one or more obligations evidencing indebtedness to Payee, evidenced by an original instrument identified as Account Number: (the "Obligation"); and

WHEREAS, the parties wish to set forth the total amounts required to satisfy and fully pay off the Obligation and the terms under which Payee will accept such payoff and release Payor from further liability upon receipt of the specified amounts; and

WHEREAS, the parties agree that upon receipt and clearance of the Payoff Amount as defined below, Payee shall provide a written release or satisfaction of the Obligation in accordance with this Financial Payoff Document.

SCOPE OF WORK / TRANSACTION DESCRIPTION

Describe the services, transaction, or account activity that gives rise to this payoff and any conditions precedent to payoff:

PAYMENT TERMS

Outstanding Principal:    Accrued Interest:

Other Charges / Fees:    Total Payoff Amount (to be paid in full):

Payment Due Date:    Method of Payment:

If payment is not received by the Payment Due Date, Payee shall assess a late fee of:    and interest thereafter at: .

TERM AND TERMINATION

This Financial Payoff Document commences on Start Date: and terminates on End Date: unless earlier terminated in accordance with this section.

Either party may terminate this Document for material breach that remains uncured after the expiration of the notice period set forth above. Termination shall not affect Payee's right to recover amounts accrued prior to termination.

CONFIDENTIALITY

The parties acknowledge that the terms of this Financial Payoff Document and any non-public information exchanged in connection with the payoff are confidential and shall not be disclosed to third parties except as required by law or with the prior written consent of the other party.

Acknowledgement of Confidentiality: By checking this box, the signing party affirms understanding and acceptance of the confidentiality obligations set forth herein.

RELEASE UPON PAYOFF; CERTIFICATION

Upon receipt of the Total Payoff Amount in cleared funds, Payee shall execute and deliver to Payor a written release, satisfaction, or reconveyance as applicable, releasing Payor from any further monetary obligations under the Obligation identified above. Payee certifies that the Total Payoff Amount, when paid as provided herein, will constitute full satisfaction of the Obligation, subject only to any separate written agreement to the contrary signed by both parties.

GOVERNING LAW

This Financial Payoff Document shall be governed by and construed in accordance with the laws of the State of: , without regard to its conflict of laws principles.

ENTIRE AGREEMENT

This Document, together with any written exhibits or schedules specifically incorporated herein, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior negotiations, understandings and agreements between the parties relating to such subject matter. No amendment or modification shall be effective unless in writing and executed by both parties.

MISCELLANEOUS PROVISIONS

Representations: Each party represents and warrants that it has full power and authority to enter into this Document and that the person executing this Document on its behalf is duly authorized to do so.

Notices: All notices required or permitted under this Document shall be in writing and delivered to the addresses for the parties as set forth below or as subsequently designated in writing.

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