MLO Name

First Name

Last Name

Primary Borrower Name *

Primary Borrower, First one on Application

First Name

Last Name

Borrower Goal

Purchase

R/T Refi

Cash Out Refi

Other (include notes in Important Notes box below)

Application Fee

Waive UW Fee (included in rate)

Charge on LE

Compensation Structure

Lender Paid

Borrower Paid

Borrower Docs

Uploaded in Encompass

Emailed to Processor

Saved in Pipeline/Prospect Shared Drive

No Docs, Request from Borrower

Other (include in important notes section below)

Referral Source Full Name *

Who referred the deal to you?

First Name

Last Name

Referral Type *

Company Sourced

Self Sourced

Did you receive assistance from Tom with this file?

Yes

No

Was the borrower or realtor referred by Meena Tawfik? *

Yes (If yes, please include the name of the borrower/realtor referral in the Important Notes section)

No