Missouri Loan Brokerage Fee Agreement And Brokerage Disclosure Statement Form Page 2
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210.
This Brokerage Agreement is the only agreement between the Borrower and the Broker, except for a
Rate-Lock Fee Agreement in accordance with 4 CSR 140-30.110.
Brokerage Disclosure Statement
(Title 4 CSR 140-30.080 (2))
The Borrower acknowledges by signing below that they understand the following:
1.
The Broker does not make loans.
2.
Actual funds are provided by another entity, which may affect availability of funds.
3.
Name(s) in which Broker has operated under during preceding ten (10) years:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________.
4.
Name(s) of any parent or affiliated companies:
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________.
5.
Broker is a:
____ Individual
____ Corporation
____ Partnership
____ Association
6.
The Broker:
____ Brokers loans to only one (1) entity.
____ Brokers loans to more than one (1) entity.
THE UNDERSIGNED APPLICANT HAS READ AND UNDERSTANDS THE ABOVE
BROKERAGE DISCLOSURE STATEMENT OR HAS HAD THE CONTENTS EXPLAINED BY
SOMEONE NOT CONNECTED WITH THE BROKER,
The undersigned Borrower has read and acknowledged receipt of the Loan Brokerage Fee Agreement and
the Loan Brokerage Disclosure Statement. This Agreement has been executed on the same date written
below by the Borrower and the Broker.
___________________________________
________________________________________
Borrower
Date
Borrower
Date
BROKER:
BY: ______________________________________________________
________________
Its Authorized Representative
Date
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