COMPANY INFORMATION:
Company Name:
DBA’s or Affiliates:
Company Address:
Phone #: Fax #:
Email Address: Web Address:
Corporation Partnership LLC Sole Proprietorship
Federal Tax ID #:
List full names and the % ownership of all owners with > 25% interest:
OTHER INFORMATION:
Are any of the owners / officers a licensed realtor, licensed real broker, or licensed mortgage
broker? No If yes, please list names, license type, license #:
Have any of the owners / officers participated in educational programs for legally and ethically
buying and selling short-sale properties, distressed sales or REO purchases from lenders?
No If yes, please list programs / dates attended /explain in as much detail as possible:
Have any of the owners or officers and /or directors been convicted, plead guilty or no-contest to
a crime? No If yes, please explain in detail:
Are you, the company or any of the owners or officers and /or directors of the company party to
a lawsuit? No If yes, please explain in detail:
Are there any outstanding judgments against you, the company, or any of the other owners
and/or directors of the company? No If yes, please explain in detail:
Please attach / send copies of the following:
• Articles of Incorporation/Organization
• Bylaws or Operating Agreement
• Certificate of Good Standing from state
• Any professional licenses for owners / officers.