Acknowledgements and Respresentation. The parties signing below acknoweldge they have read and understood this agreement and have each received a copy. The Principals warrant they have the authority to enter into this agreement with regard to the Subject Property and loan(s) herein described. Name(s) of Principal(s) Signature Date Name(s) of Principal(s) Signature Date Name(s) of Principal(s) Signature Date Name(s) of Principal(s) Signature Date Name(s) of Principal(s) Signature Date Broker Name/Designated Officer Name Signature Date Broker(Corporation) License Number VERIFIED ACCOUNTING FOR ADVANCE FEES Broker (Corporation) Name: Principal Name: Broker Address: Principal Address: Broker Trust Account # : Lender Name: Depository: Loan Account Number: 2nd Lender Name: 2nd Loan Account Number: Advance Fee Accounting AdvanceFee Amount Received From(Principal) Date Received Date Deposited in trust account Balance Services Performed by Broker Date Performed Amount of Fee Allocated Date Disbursed Balance All Phase I services including: Loan Modification Package submitted to Lender at (address): Loan Modification Package submitted to 2nd Lender at (address): All Phase II services including Successful Loan Modification I hereby represent and arrest that this is a true and accurate accounting. Signed Date Broker Name License Identification Number
