Submission Date:________________________
Broker Name:____________________________________________________________
Loan Officer Name:_______________________________________________________
Telephone:_________________ Ext:________ Fax Number:____________________
Borrower's Name:________________________________________________________
Subject Address:_________________________________________________________
TYPE OF LOAN: (Circle One) PURPOSE OF LOAN: (Circle One)
FHA Purchase
VA | Streamline Refinance/No Cash Out
Conforming Conventional Refinance/Cash Out
Non-Conforming Conventional 2nd Mortgage/Heloc
Other:________________________
IMPOUNDS: _____ None _____ Taxes Only _____ Hazard Only _____ Both
BROKER TO PAY ALL NON-RECURRING CLOSING COSTS: _____ Yes _____ No
SUBMIT LOAN TO THE FOLLOWING LENDER:
Lender Name:__________________________ Telephone:________________________
Contact Person A/E:_____________________ Telephone:_______________________
E-mail Address:_________________________ Website:________________________
Program:_______________________ Rate:__________ Locked: _____Yes _____ No
Loan Amount: $____________ Value: $____________ Sales Price: $______________
Term/Months_____ Interest Only_____ LTV_____% CLTV____% Ratio _____ / ____
ESCROW COMPANY:
Escrow/Closing Name:__________________________ Telephone:_________________
Escrow Officer:_____________________ E-mail Address:________________________
Address:________________________________________________________________
TITLE COMPANY:
Title Company Name:___________________________ Telephone:_________________
Title Officer:________________________ E-mail Address:________________________
Address:________________________________________________________________
APPRAISAL COMPANY:
Appraisal Company Name:_________________________________________________
Appraiser:__________________________ E-mail Address:_______________________
Telephone:_________________________ Fax Number:__________________________
__________________________________
Signature
Broker/Loan Officer