Texana Bank Mortgage
Real Estate Agent Mortgage Loan Officer Questionnaire
Amy Brand
(228) 200-1091 | Amy.Brand@texanabank.com
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Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Position
*
Please Select
Solo Broker
Brokerage Owner / Branch
Other
Personal License #
*
Brokerage Name
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal | Year to Date Buyer Purchases (Units)
*
Personal | Year to Date Buyer Purchases ($)
*
Personal | Previous Year to Date Buyer Purchases (Units)
*
Personal | Previous Year to Date Buyer Purchases ($)
*
Personal | Pending or Previous Litigation or Disciplinary Action?
Please Select
Yes
No
If Yes, Please Explain
Resume if available
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Do you MANAGE or OWN a branch?
Please Select
Yes
No
Broker License #
Branch | YTD Buyer Purchases (Units)
Branch | YTD Buyer Purchases ($)
Branch | Previous Year Buyer Purchases (Units)
Branch | Previous Year Buyer Purchases ($)
Number of agents if applicable
Years Branch Has Been Established
Branch | Pending or Previous Litigation or Disciplinary Action?
Please Select
Yes
No
If Yes, Please Explain
Branch Roster if applicable
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The Caxton Building | 812 Huron Rd. E Suite 719, Cleveland, OH 44115
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