| New Loan Registration Form |
| EXECUTIVE SUMMARY* |
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| BROKER CONTACT INFORMATION |
| Broker Company: |
Faith Financial Group, Inc. |
Branch Office: |
Minnesota |
| Contact Name: |
Russel Davies |
Origination Contact: |
Russ |
| Phone #1: |
952-432-8455 |
Phone #2: |
952-382-3230 |
Phone: |
952-432-8455 |
| E-mail: |
faithfinancialgr@aol.com |
Fax: |
952-891-8472 |
| Fax #: |
952-891-8472 |
E-mail: |
faithfinancialgr@aol.com |
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| PROPERTY ACCESS INFORMATION |
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| LOAN PROGRAM |
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| PROPERTY INFORMATION |
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| BORROWER(S) / GUARANTOR(S) |
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| CONSOLIDATED SCHEDULE OF REAL ESTATE OWNED (Combine all borrowers) |
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INFORMATION FOR GOVERNMENT MONITORING PURPOSES Please complete for 2 primary guarantors |
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The following information is requested by the Federal Government for certain types of loans
related to a dwelling in order to monitor the lender's compliance with equal credit opportunity,
fair housing and home mortgage disclosure laws. You are not required to furnish this information,
but are encouraged to do so. The law provides that a lender may discriminate neither on the basis
of this information, nor on whether you choose to furnish it. If you furnish the information,
please provide both enthinicity and race. For race, you may check more than one designation.
If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required
to note the information on the basis of visual observation or surname. If you do not wish to furnish
the information, please check the box below. (Lender must review the above material to assure that
the disclosures satisfy all requirements to which the lender is subject under applicable state law
for the particular type of loan applied for.)
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| GUARANTOR |
I do not wish to furnish this information |
CO-GUARANTOR |
I do not wish to furnish this information |
| Ethnicity |
Hispanic or Latino
Not Hispanic or Latin |
Ethnicity |
Hispanic or Latino
Not Hispanic or Latin |
| Race |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White |
Race |
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White |
| Sex |
Female
Male |
Sex |
Female
Male |
| Interviewer's Name |
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| Interviewer's Signature |
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| Interviewer's Phone |
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