Vendor Application

Business Information

Owner / Officer / Broker Information (must be the person completing this application)

Experience & Logistics

  
Specialty:  

Mortgage-Related Business ReferencesRequired

Do you know any loan officers who you can refer?

Legal Questionnaire

Have you ever been suspended by a lender?  
By whom, the reason, and how was it resolved, if at all?
Have you ever had your license suspended or revoked by the DRE?  
By whom, the reason, and how was it resolved, if at all?
Have you ever been found guilty of a felony in a court of law?  
By whom, the reason, and how was it resolved, if at all?
Is there any pending litigation against you?  
By whom, the reason, and how was it resolved, if at all?

IMPORTANT: PLEASE READ CAREFULLY

The information contained herein is correct to the best of my knowledge. I hereby authorize C2 Financial Corporation and its designated agents and representatives to conduct a comprehensive review of my background causing a consumer report and/or an investigative consumer report to be generated for employment and/or volunteer purposes. I understand that the scope of the consumer report/ investigative consumer report may include, but is not limited to the following areas: verification of social security number; current and previous residences; employment history, education background, character references; drug testing, civil and criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; driving records, birth records, and any other public records.

I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to C2 Financial Corporation or its agents. I further authorize the complete release of any records or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include information or data received from other sources.

I hereby release C2 Financial Corporation, the Social Security Administration, and its agents, officials, representative, or assigned agencies, including officers, employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and request to release.