Xyz Mortgage Services Fee Agreement Form Page 2
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1
2
33.
Total Points, Fees and Commissions
$___________
Percent of Points, Fees and Commissions in relation to
___________%
loan amount (Item 3/Item2)
Total of Yield Spread Premium, Points, Fees and
$___________
Commissions (Item 1 + Item 3)
Percent of Yield Spread Premium, Points, Fees and
$___________
Commissions in relation to the total loan amount
It is also understood that no fee will be charged if either the applicant or lender turns down the loan.
This loan may be co-brokered; that is XYZ Mortgage Services, Inc. may share mortgage broker
services or fees with another mortgage broker on behalf of the applicant. Within three days of making
a final decision to co-broker a loan, XYZ Mortgage Services, Inc. will provide applicant with written
notice of such co-brokering.
Agency to Receive Borrower Complaints
The following agencies are designated to receive complaints or inquiries about the origination and
making of your mortgage:
Street
South Carolina Department of Consumer Affairs
Address
2221 Devine Street, 2nd Floor
Columbia, SC 29205
Mailing
P.O. Box 5757
Address
Columbia, SC 29250
Phone
803-734-4200 or toll free in SC only 1-800-922-1594
I acknowledge by my signature that I have received a fully executed copy of this disclosure at the
time of my application for a mortgage, it has been explained to me and I understand it, I understand
that a copy of this disclosure will be maintained in my file with my mortgage broker and further, I
voluntarily enter into this mortgage transaction.
__________________________________
NAME (please print)
__________________________________
___________________________________
CLIENT’S SIGNATURE
DATE SIGNED
__________________________________
NAME (please print)
__________________________________
___________________________________
CLIENT’S SIGNATURE
DATE SIGNED
By signing below, the mortgage broker certifies that the information in this contract is accurate and
complies with all provisions of section 8 of the Real Estate Settlement Procedures Act, 24 CFR part
3500 and South Carolina Law.
By: __________________________________
__________________________________
XYZ Mortgage Services, Inc.
DATE SIGNED
Mortgage Broker Fee Agreement
Rev. 06/12
Page 2 of 3
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