Corporate Office Eastern Regional Office
9680 Haven Ave. Suite 300
Rancho Cucamonga, CA 91730
Tel : 909-348-1600 / Fax : 909-266-8605
E-mail : esubmit2ca@mhlmtg.com
2700 N Berkeley Lake Rd. Building A, Suite 300
Duluth, GA 30096
Tel : 678-879-5000 / Fax : 678-935-1350
E-mail : esubmit2ga@mhlmtg.com

Broker Information
Date Acct. Exec
Company name Broker ID
Loan Officer Contact
Phone Fax
Email
Borrower Information   Spouse Information
Borrower Name
SSN
Address
City
State
Zip
Residency Status
Employment Status
Spouse Name
SSN
Address
City
State
Zip
Residency Status
Employment Status
Property Information
Property Address
City
State Zip
Occupancy Type Property Type
Seller's Full Name
Loan Information
Loan Program
Register Number (If pre-Locked)
Loan Purpose Documentation Type
Appraisal Value $0.00 LTV/CLTV
Sales Price $0.00 Credit Score
Loan Amount $0.00 Term/Due
Cash-Out Amount $0.00 Interest Rate 0.00%
Impound ? Start Rate(JO100) 0.00%
Pre-Pay Penalty Margin(JO100) 0.00%
Interest Only Projected Close Date
2nd Loan with ?
I/We hereby assign and transfer all rights, title and interest in the above referenced loan package to Majestic Home Loan
I/We hereby certify that all disclosures required by law were given to the borrower(s) within three (3) business days of the completion of the original application. I/We hereby indemnify Majestic Home Loan, their successors and/or assigns from any and all claims and/or losses that may arise from the issuance of such required disclosures.
I/We hereby certify that all copies in the above referenced loan package submitted to Majestic Home Loan are true and exact copies of the original documents that I/we witnessed, and from which we took copies.
Print Name :     Date : 7/25/2014
Signature :     Date : 7/25/2014