About your company

what should we call you?

Tax Details

How do we hold you accountable?

Principals of the company

Who is responsible?

Origination Details

How well do you originate?

Investor/Bank References

  • About your company
  • Tax Details
  • Principals of the company
  • Origination Details
  • Investor/Bank References

Company names

Legal name of company

DBA Name(s), if applicable

Where are you located

Business street address

City

State

Zip Code

Who do we contact?

Primary contact person name

Primary contact person email

Secondary contact person name

Secondary contact person email

Phone Numbers

Business phone number. Please enter numbers only.

Business fax number. Please enter numbers only.

Tax info

Federal Tax ID

Office Details

Total Number of Offices

Will branches be submitting directly

Principal 1

Name

Title

Percentage of ownership

Social security number. Please enter numbers only.

Home Phone Number. Please enter numbers only.

Home Address

Principal 2

Name

Title

Percentage of ownership

Social security number. Please enter numbers only.

Home phone number. Please enter numbers only.

Home address

Principal 3

Name

Title

Percentage of ownership

Social security number. Please enter numbers only.

Home phone number. Please enter numbers only.

Home address

More principals?

Do you have more than 3 principals?

If you have more than 3 principals, we will contact you and get it all sorted out.

Origination area

Primary geographic origination area

Origination volume

Prior year origination value $

Prior year origination value # of units

Year to date origination value $

Year to date origination value # of units

Do you accept loans from other mortgage brokers, i.e. Third Party Originations?

In the last 10 years has your company or any of its officers been suspended or removed by any lender or investor from selling or servicing mortgages?

If yes, please specify

Reference 1

Investor/Bank Name

Length of Relationship

Contact Name

Contact Phone Number. Please enter numbers only.

Contact Email

Reference 2

Investor/Bank Name

Length of Relationship

Contact Name

Contact Phone Number. Please enter numbers only.

Contact Email

Reference 3

Investor/Bank Name

Length of Relationship

Contact Name

Contact Phone Number. Please enter numbers only.

Contact Email

Reference 4

Investor/Bank Name

Length of Relationship

Contact Name

Contact Phone Number. Please enter numbers only.

Contact Email

Online Form December 10, 2018