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*
First
*
Last
Title
*
Company
*
Business Address
*
City
*
State
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*
Zip
*
Phone
*
Email
Fax
*
Company's Legal Structure
--Please select--
Corporation
Proprietorship
Partnership
Other
*
How long has the company/institution been in business?
*
Is company a subsidiary or division of another company?
--Please select--
Yes
No
If yes to the question above, please indicate the company's name/address
*
Please indicate the focus of your business:
--Please select--
Residential
Commercial
Both
Origination
Servicing
Secondary
*
Please indicate the appropriate category
Mortgage Banker
Mortgage Broker
Commercial Bank
Commercial Lender
S&L/Savings Bank
Life Insurance Co.
MI Company
Title Insurance Company
*
Channels/Products
Retail
Wholesale/Conventional
Subprime
FHA
VA
Other
Please indicate below agency your company/institution is licensed by (if applicable)
--Please select--
Division of Banks & Real Estate Finance
Dept. of Financial Institutions
Other
*
Has your license ever been revoked or suspended?
(If yes, please explain in accompanying letter)
--Please select--
Yes
No
*
Are you an FHA-approved mortgagee?
--Please select--
Yes
No
If answered yes to the question above, have you ever been suspended by FHA or VA?
(If yes, please explain in accompanying letter.)
Yes
No
*
Are you a FANNIE MAE / FREDDIE MAC-approved seller/servicer?
--Please select--
Yes
No
*
Please list your company's origination volume (Illinois Loans only)
$__Million (most recent fiscal year end)
*
Please list your company's servicing volume (Illinois Loans Only)
$__Million (most recent fiscal year end)
Please list the principal institutional investors you represent (if applicable)