Legal Name of the Entity *
Company NMLS# *
Doing business as
Street address (No P.O. Box) *
City *
State *
ZIP Code*
Phone *
Contact Email *
Broker of record
Broker NMLS#
Full name *
Title *
Last Four SSN *
I/We hereby certify that Mortgage Brokerage is in good standing with any and all applicable regulatory agencies. I/We further certify that said Mortgage Brokerage is not a defendant in any litigation alleging fraud, misrepresentation or dishonest acts. For the purpose of inducing A&D Mortgage LLC to provide financing for clients of the undersigned, I/We certify that all information contained in this application is true and correct.
The undersigned applicant(s) authorize(s) the release to A&D Mortgage LLC of any and all Information about the applicant(s) deemed necessary by A&D Mortgage. The applicant(s) also agree(s) that A&D Mortgage LLC, from time-to-time, may request and secure additional information.
I/We Agree to the Following: 1. Receive Text and Multimedia Messages (SMS/MMS): I/We hereby consent to receive text and multimedia messages (SMS/MMS) from A&D Mortgage LLC for updates, news, and information. I/We understand that standard message and data rates may apply, and I can opt out at any time by replying with "STOP" to info@admortgage.com. 2. Communicate via Social Networks: I/We consent to be contacted by A&D Mortgage LLC via social networks (including but not limited to Facebook, Twitter, LinkedIn/Instagram) for updates, news, and information. I/We understand that I/We can modify my communication preferences through my social network account settings at any time. 3. I/We acknowledge that A&D Mortgage LLC will keep my contact information confidential and will not share it with third parties without my explicit consent. (Note: By clicking "Submit," you are confirming your agreement to the above terms. You can withdraw your consent at any time by contacting us at A&D Mortgage LLC.)
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