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Form A Date: Prospective Applicant: Mortgage Broker or Loan Officer: License Number _______________ Address ______________________ Phone # ______________________ Loan (describe as follows): Loan Amount: Qualifying Interest Rate: Term: Maximum Loan-to-Value Ratio: Loan Type and Description: Mortgage Broker ¨ has ¨ has not received a signed application for the Loan from the Prospective Applicant Mortgage Broker ¨ has ¨ has not reviewed the Prospective Applicant's credit report Mortgage Broker ¨ has ¨ has not reviewed the Prospective Applicant's credit score Mortgage Broker has reviewed the following additional items (list): The Prospective Applicant has provided the Mortgage Broker ¨ verbally ¨ in writing with information about the Prospective Applicant: [ Income ____Yes ____No ____Not Applicable Available cash ____Yes ____No ____Not Applicable Debts ____Yes ____No ____Not Applicable Assets ____Yes ____No ____Not Applicable Based on the information that the Prospective Applicant has provided to the Mortgage Broker, as described above, the Mortgage Broker has determined that the Prospective Applicant is eligible and qualified to meet the financial requirements of the Loan. This is not an approval for the Loan. Approval of the Loan requires: (1) the Mortgage Broker to verify the information that the Prospective Applicant has provided; (2) the Prospective Applicant's financial status and credit report to remain substantially the same until the Loan closes; (3) the collateral for the Loan (the subject property) to satisfy the lender's requirements (for example, appraisal, title, survey, condition, and insurance); (4) the Loan, as described, to remain available in the market; (5) the Prospective Applicant to execute loan documents the lender requires, and (6) the following additional items (list):
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