Commercial Loan Broker Agreement Form
Use this form to capture broker, client, loan request, compensation, and agreement details for a commercial loan brokerage arrangement.
Broker and Client Information
Broker Company / Legal Name
*
Broker Contact Person Full Name
*
First Name
Middle Name
Last Name
Business Email
*
example@example.com
Business Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Client Company / Legal Name
*
Client Contact Person Full Name
*
First Name
Middle Name
Last Name
Title / Role
Business Email
*
example@example.com
Loan Request Details
Loan Purpose
*
Please Select
Working Capital
Equipment Financing
Commercial Real Estate
Refinance
Business Expansion
Other
Loan Type
*
Working Capital
Equipment Financing
Commercial Real Estate
Refinance
Business Expansion
Other
Requested Loan Amount
*
Desired Repayment Term
Preferred Funding Timeline
Please Select
ASAP
Within 2 Weeks
Within 30 Days
Within 60 Days
Flexible
Other
Business / Project Description
*
Brokerage Terms and Compensation
Brokerage fee structure
*
Success fee
Flat fee
Hourly fee
Retainer plus success fee
Other
Fee amount or percentage
*
When is the fee earned?
*
Please Select
Upon loan approval
Upon loan closing
Upon funding
Upon client acceptance of terms
Other
Who is responsible for payment?
*
Please Select
Client
Borrower
Lender
Third party
Other
Arrangement type
*
Exclusive
Non-exclusive
Special compensation terms
Authority, Acknowledgment, and Signature
Authorization Confirmation
*
I authorize the broker to represent me to lenders for this loan request.
I confirm the broker may share my information with prospective lenders.
I acknowledge I am authorized to submit this request on behalf of the client.
Other
Acknowledgment of Information Accuracy
*
I confirm the information provided is true and complete to the best of my knowledge.
I agree to promptly notify the broker of any material changes.
Other
No Guarantee Acknowledgment
*
I understand the broker does not guarantee loan approval, terms, or funding.
I acknowledge lender decisions are made independently by lenders.
Other
Agreement Effective Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client and Broker Signatures
*
Submit Agreement
Submit Agreement
Should be Empty: