Client Approval

DOCUMENT REQUIREMENT CHECKLIST • Completed Broker Application • Client Contract • Anti-Fraud Agreement • Resolution of Board of Directors • Lender Paid Broker Compensation Agreement • Anti Money Laundering Program Verification • Copy of Resume • Employee Roster • List of State License(s) • QC Plan • Most Recent Financials • Company Website

Name

First Last

Legal Name of Company

D.B.A Names(s)

Account Representative

Addresses of Loan Origination Office(s) (please attach if more than two):

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

List of Loan Origination Officers

Name

Phone Number

Email

NMLS

Rate Sheets:

Underwriting Sheets:

Rate Lock Confirmations

Names and Titles of Owners and Principal Officers (please attach if more than three):

Name

First

Title

% Ownership/Shares

Social Security

Name

First

Title

% Ownership/Shares

Social Security

Name

First

Title

% Ownership/Shares

Social Security

Upon receipt of this application, you will be contacted by a representative of Mortgage Assurance, Inc. for a brief interview. Please provide your representative's name and the best time to reach him or her.

Name

First

Time

:

Name

First

Time

:

The undersigned being duly authorized to complete this application states that the information contained herein is true and correct.

Name

First

Date

Name

First

Time

:

Application Form