Primary Contact

First Name *

Last Name *

Title

Direct Phone

Email *

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Loan Officers

List loan officers who will submit loans to Northstar. Enter as many as needed in the fields below.

Loan Officers (Name / Individual NMLS # / State(s) / Email)

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Business Profile

Approximate Annual Loan Volume

Approximate Number of Loans Closed / Year

Primary Loan Products Originated

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Insurance & Bonding

Errors & Omissions (E&O) Carrier

E&O Coverage Amount

Fidelity Bond Carrier

Fidelity Bond Coverage Amount

Authorization

By signing below, I certify that the information provided in this application is true and accurate to the best of my knowledge, and I authorize Northstar Mortgage Lending, LLC to verify licensing, insurance, and background information as part of the broker approval process.

Authorized Signature *

Title *

Date *

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Broker Application

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Company Information