Real Estate Agent CLO Form

Real Estate Agent Computer Loan Origination (CLO) Form

Items in Red are Mandatory and Must be Completed

Borrower Personal Information:

First Name
Last Name
Middle Initial
Home Address
City
State
Zip
	Rent Own
Time at Address	Years Months
Home Phone
E-mail

Date of Birth

Sex Male Female

Social Security Number

Borrower Employment Information:

The borrower is:

Self-Employed
Not Self-Employed

Employer Name
Job Title
Street Address
Address (cont.)
City
State
Zip
Time on Job	Years Months
Annual Income
Work Phone
FAX

Co-Borrower Personal Information (if applicable):

Only complete address information if different than borrowers

First Name
Last Name
Middle Initial
Home Address
City
State
Zip
	Rent Own
Time at Address	Years Months
Home Phone
E-mail

Date of Birth

Sex Male Female

Social Security Number

Co-Borrower Employment Information (if applicable):

The co-borrower is:

Self-Employed
Not Self-Employed

Employer Name
Job Title
Street Address
Address (cont.)
City
State
Zip
Time on Job	Years Months
Annual Income
Work Phone
FAX

Property and Loan Information:

What is the desired loan type?
What is the appraisal value of the property?	$
What is the desired loan amount or pre-approval request amount?	$
What is the estimated down payment amount?	$

Real Estate Agent Information:

Agent Name
Agent Phone
Agent Email
Loan Officer Requested
Agent Notes

Click here for CLO disclosure

I/We (borrower[s] named herein) understand that this form is for pre-qualification only and is not an application.

Authorization to check credit verification

You understand that by selecting the YES radio button immediately following this notice you are providing written instructions to First Security Mortgage Company under the Fair Credit Reporting Act authorizing First Security Mortgage Company to obtain information from your personal credit profile or other information from the credit bureau. You authorize First Security Mortgage Company to obtain such information solely in accordance with a Mortgage Loan Application. If this form is completed by a Real Estate Agent on behalf of a client, Agent attests that permission for obtaining credit was obtained from client(s).
YES NO