New York Mortgage Banker And Exempt Organization Pre-Application Disclosure Form

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NEW YORK MORTGAGE BANKER AND EXEMPT
ORGANIZATION PRE-APPLICATION DISCLOSURE
Borrower Name(s):
Lender:
Property Address:
Date:
___________________________________________________________________________________
FEE ACKNOWLEDGMENT
The following fees may be charged in connection with the processing of your loan application. Other fees not shown
here may be payable later and are shown on the Good Faith Estimate of Closing Costs. Nonrefundable fees are
subject to applicable limitations of state or federal law.
Name of Fee
Amount
Important Information
Application Fee
$ _____________
The application fee is refundable if: __________________
______________________________________________
Appraisal Fee
$ _____________
The appraisal fee is non-refundable except that amounts
collected in excess of the actual cost will be refunded. If the
appraisal has not been done, the fee will be refunded in full.
Credit Report
$ _____________
The credit report fee is non-refundable except that amounts
Deposit
collected in excess of the actual cost will be refunded. If the credit
report has not been done, the fee will be refunded in full.
Processing Fee
$______________
The processing fee is refundable if: ___________________
________________________________________________
The property appraisal fee and the credit report fee are estimates of the actual cost of the services. Should the
actual costs exceed the estimate, you understand that you will be billed and will pay the shortfall at or prior to closing.
 ASSIGNMENT
We routinely assign commitments issued in our name to:
Assignee Name: ___________________________________________________________________
Assignee Address: _________________________________________________________________
__________________________________________________________________
Will provide you with the following service(s): ____________________________________________________
________________________________________________________________________________________
A fee in the amount of $ _____________ will be paid to: ___________________________________________
PREPAYMENT PENALTIES
You understand that certain mortgage products impose a prepayment penalty on the borrower. We will disclose the
amount of, or the formula for calculating, the prepayment penalty, and the terms of the prepayment penalty, if any, as
soon as we know them.
LENDER CONTACT
If you have any questions regarding your application, please contact:
Name: ____________________________________________________________________________
Lender’s Name: ____________________________________________________________________
Lender’s Address: ___________________________________________________________________
*Telephone Number: _________________________________________________________________
*If you live more than 50 miles from the office at which your file is being processed, you may call us toll free
at ___________________________, or if unavailable, you may call us collect.
I/We have read the above disclosure and acknowledge receiving a copy by signing below.
________________________________________
________________________________________
Borrower
Date
Borrower
Date
________________________________________
________________________________________
Borrower
Date
Borrower
Date
________________________________________
________________________________________
Borrower
Date
Borrower
Date

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