Mortgage Lender Referral Fee Disclosure Form
Please complete this form to document the details and acknowledgment of the referral fee arrangement between the referring party and the mortgage lender.
Referring Party Name
*
First Name
Last Name
Referring Party Business/Company Name
*
Referring Party Email Address
*
example@example.com
Referring Party Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mortgage Lender Name
*
First Name
Last Name
Mortgage Lender Business/Company Name
*
Referred Client Name
*
First Name
Last Name
Referral Fee Amount or Percentage (e.g., $1,000 or 1%)
*
Referral Fee Payment Timing/Method
*
Please Select
Upon loan closing
Within 30 days of closing
Other (please specify below)
I acknowledge and agree that the above referral fee arrangement has been fully disclosed and authorized as required by law.
*
I acknowledge and agree
Submit Referral Fee Disclosure
Should be Empty: