Broker Mortgage Loan Application

BROKER MORTGAGE LOAN APPLICATION AND BROKERAGE AGREEMENT

WHEREAS

WHEREAS Broker Name: is duly authorized and licensed to act as a mortgage broker and to solicit, negotiate and procure mortgage financing on behalf of borrowers; and

WHEREAS Applicant Name: seeks to obtain mortgage financing for the Property described below and engages Broker to assist in locating and arranging such financing under the terms set forth in this Agreement and Application; and

WHEREAS the parties desire to set forth the scope of brokerage services, applicant representations, payment of broker compensation and related terms and conditions in a single executable instrument.

APPLICANT INFORMATION

PROPERTY AND LOAN INFORMATION

Loan Purpose:   Requested Loan Amount:

Estimated Property Value:   Down Payment / Equity:

EMPLOYMENT, INCOME, ASSETS AND LIABILITIES

DECLARATIONS AND AUTHORIZATIONS

By checking the boxes below, Applicant makes the following certifications and authorizations:

No bankruptcy within the past seven years

No foreclosure or short sale within the past seven years

Applicant authorizes Broker and its agents to obtain credit reports, verify employment, assets and other information necessary to process this application

Applicant understands that false statements or omissions may constitute fraud and may result in denial of financing or legal liability.

SCOPE OF WORK

Broker will act as finder and intermediary to locate potential lenders, present the Applicant's loan application, assist with the preparation of loan documentation, and use commercially reasonable efforts to negotiate loan terms acceptable to Applicant. Broker will not itself extend credit unless separately disclosed.

PAYMENT TERMS

Broker Compensation Amount: $   Payable:

Late Payment Fee (if any):   Collection Costs: Applicant agrees to pay reasonable collection costs and attorney fees if payment obligations are not met.

TERM AND TERMINATION

Agreement Start Date:   Agreement End Date:

Either party may terminate this Agreement for convenience upon written notice delivered to the other party at least days prior to termination. Termination does not relieve Applicant from paying any broker fees already earned under this Agreement or reimbursing Broker for out-of-pocket expenses incurred with Applicant's prior written consent.

CONFIDENTIALITY

Except as required to effectuate the services contemplated herein, the parties shall maintain in confidence all non-public financial and personal information delivered by one party to the other. Broker may disclose Applicant information to lenders, credit bureaus, title companies and other third parties reasonably necessary to procure financing. This obligation survives termination of this Agreement for a period of two years.

GOVERNING LAW; ENTIRE AGREEMENT

Governing Law: This Agreement shall be governed by and construed in accordance with the laws of the State of without regard to conflict of law principles.

Entire Agreement: This Agreement, including any appendices or disclosures executed by the parties, contains the entire understanding between the parties relating to the subject matter hereof and supersedes all prior and contemporaneous agreements, representations and understandings, whether oral or written. Any modification must be in writing and signed by both parties.

BROKER COMPENSATION AND DISCLOSURE

Broker may receive compensation from Applicant and/or from lenders. Broker discloses that compensation may include origination fees, yield spread premiums, lender-paid fees and referral fees. Applicant acknowledges receipt of a separate Broker Compensation Disclosure if required by applicable law.

Compensation paid by lender to Broker will be:

Compensation paid directly by Applicant will be:

REPRESENTATIONS AND WARRANTIES

Applicant represents and warrants that all information provided in this Application is true, complete and accurate to the best of Applicant's knowledge. Applicant will promptly update Broker regarding any material changes to income, assets, liabilities or employment that occur prior to loan closing. Broker makes no guarantee of loan approval; Broker agrees to use commercially reasonable efforts to arrange financing consistent with Applicant instructions.

INDEMNITY

Applicant shall indemnify and hold Broker harmless from and against any claims, losses, liabilities, costs and expenses (including reasonable attorney fees) arising from Applicant's breach of this Agreement, misrepresentations, or failure to disclose material facts, except to the extent caused by Broker's gross negligence or willful misconduct.

ADDITIONAL NOTICES

Applicant understands that Broker will provide copies of all completed loan application documents and material disclosures to Applicant and that certain lender fees and third-party charges may be incurred whether or not the loan closes.

ACKNOWLEDGMENT

By signing below, Applicant authorizes Broker to act on Applicant's behalf as set forth herein, acknowledges receipt of this Application and Brokerage Agreement, and certifies that Applicant has read and understood all terms, fees, and authorizations contained herein.

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