(Use YYYY-MM-DD for date and HH:MM:SS for time)

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If YES, please explain by emailing your Baker Collins representative.

If you are working with a partner, they must also complete this form.

In applying for a loan or prequalification, I/we have made various statements about my/our income, assets, experience and other pertinent information LSI Mortgage Plus and its associates/affiliates. is relying upon for final loan approval. LSI Mortgage Plus and its associates/affiliates reserves the right to change the terms & conditions of any approval subject to the validity of the information provided to us. I/we understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make false statements when applying for this mortgage, as applicable under the terms and provisions of Title 18, United States Code, Section 1014. I/we authorize LSI Mortgage Plus. & their affiliates to verify any statements made or information provided, including obtaining a background check and copy of my/our credit
report. I/we understand this will be used for the purpose of purchasing investment Real Estate Property. I/we understand that completion of this form does not guarantee loan approval. Loan terms will be based off of credit score, appraisal and the renovation report. By clicking “I agree” to this statement, I/we digitally sign this statement and agree to its terms.