650 755-7293SAXE MORTGAGE COMPANY
950 John Daly Blvd., Suite 200, Daly City, CA 94015 (650) 755-7293 Fax (650) 755-7064
SAXE MORTGAGE COMPANY950 John Daly Blvd., Suite 200, Daly City, CA 94015 phone: (650) 755-7293 fax: (650) 755-7064
BROKER APPLICATION FORM
Company Name: ________________________________________________________________
Address: __________________________________________________ ____________________
Phone: ________________________________ Fax: _________________ __________________
Broker Of Record: ______________________________________________ ________________
Primary Contact: ________________________________ Title: ___________ _______________
Type of Company: Corporation______ Partnership______ Sole Proprietorship______
Tax ID Number: __________________________ Company in Business since_________ ______
Principals / Officers:
Full Name Title Social Security Ownership
1. ____________________ _____________ _______________________ ___________%
2. ____________________ _____________ _______________________ ___________%
3. ____________________ _____________ _______________________ ___________%
Please provide 3 Lender References:
Company Name Contact Phone
1. __________________ _____________________ _____________________
2. __________________ _____________________ _____________________
3. __________________ _____________________ _____________________
Please List Branch Offices (If additional Branch Offices, please use additional page)
| Branch Name: _________________________________ Contact Person: ________________________________ Address: ______________________________________ Branch Name: _________________________________ Contact Person: ________________________________ Address: ______________________________________ Branch Name: _________________________________ Contact Person: ________________________________ Address: ______________________________________ |
Phone No: _________________________ Title: ______________________________ Fax No:____________________________ Phone No: _________________________ Title: ______________________________ Fax No:____________________________ Phone No: _________________________ Title: ______________________________ Fax No:____________________________ |
Questions:
1. Has your company ever been suspended from selling or servicing mortgages by an investor? If yes, please provide explanation: _________________________________________________________________________________________________________
2. Has your company, and/or principals or corporate officers, been named as defendant in a lawsuit for alleged fraud or misrepresentation in connection with any real estate related activity? If yes, please provide explanation: ________________________________________________________________________________________________________
3. Has your company ever been involved or is currently involved in any litigation? If yes, please provide explanation: ________________________________________________________________________________________________________
4. Has your company, and/or principals or corporate officers, been named as defendant in a criminal proceedings/complaint/conviction for alleged fraud or misrepresentation in connection with any real estate related activity? If yes, please provide explanation: ____________________________________________________________________________________________
5. Has your company, and/or principals or corporate officers ever had a real estate or other professional license suspended or revoked, or received any other disciplinary action from a regulatory agency? If yes, please provide explanation: ________________________________________________________________________________________________________
6. Has your company, and/or principals or corporate officers, filed for protection from creditors under any provision of the bankruptcy laws within the past seven years? If yes, please provide explanation: ________________________________________________________________________________________________________
7. Has any lender enforced, or attempted to enforce, the Hold Harmless or Repurchase clause of their correspondent, revoked or received any other disciplinary action from a regulatory agency? If yes, please provide explanation: _________________________________________________________________________________________________________
The undersigned (“BROKER”) acknowledges that the (“INFORMATION”) contained herein is true and correct and be disclosed by Lender to Third parties with Broker’s prior written or oral permission. Broker authorizes Lender, Its principal officers, and staff to verify information and to conduct business credit and public information source inquiries regarding Broker. Broker agrees that Lender may disclose any information developed in its quality control review investigations to third parties. Lender will make available to Broker information obtained about Broker, provided Broker agrees to certain disclosure limitations and provided such disclosure does not breach confidentiality agreements between Lender and third parties. Broker waives any and all claims for errors, omissions, or inaccuracies in information developed or disclosed by Lender. Broker agrees to indemnify, defend and hold lender harmless for any inquiries, claims, or damages brought against Broker and caused by disclosure of information by Lender to others.
Broker of Record: Managing Officer or Owner:
Signature: ____________________ Date: ___________ Signature:_______________________ Date:______
Print/ Type Name: ______________________________ Print/ Type Name: _________________________
Broker Application Form Rev. 11/98