Loan Originator NMLSID

You, the applicant(s), agree to enter into this Mortgage loan origination Agreement with

("Broker"). Broker is not the lender.

Origination Fee

Refundable

Mortgage Loan Broker Disclosure

NonRefundable

Service

Application Fee

Appraisal Fee

Credit Report Fee

Amount

$

Broker undertakes to perform the following services for you, the prospective borrower:

$

$

Estimate of costs of Broker's services (including all compensation paid to Broker whether paid directly or indirectly):

Broker will be entitled to obtain or retain compensation from the applicant with whom it contracts if:

$

$

This fee may be refundable under thefollowing conditions:

Mortgage Loan Originator

Applicant

Property Address:

days.

Loan Number

DateMortgage Broker

This agreement will remainin effect for

Mortgage Loan Broker Disclosure-DEVMP1061B(DE) (1405)

Wolters Kluwer Financial Services Page 1 of 2VMP Bankers Systems

2014

$

By signing below, applicant(s) acknowledges receipt of a copy of this signed Agreement.

.

You may be entitled to the refund of certain monies paid to Broker if you exercise your right to rescind under the FederalTruth-in-Lending Act.

$

$

The total amount of the mortgage loan broker's compensation is: $

In no event shall the cost of these services exceed the amount disclosed in this agreement.

Refer to the attached Signature Addendum for additional parties and signatures.

Mortgage Broker

Date

Date

Date

Date

Applicant

Date

Mortgage Loan Broker Disclosure-DEVMP1061B(DE) (1405)

Wolters Kluwer Financial Services Page 2 of 2VMP Bankers Systems

2014