331 Capitola Ave. 
Suite G   
Capitola, CA  95010 
(831) 462-9385   
(fax) 462-9940   
Mail: P. O. Box 476   
Capitola, CA  95010
  

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CJ Investment Services, Inc.
  

LOAN INFORMATION STATEMENT

  

BORROWER INFORMATION 

Full Names of Borrower(s):

Mailing Address:
Vesting: 
Phone Number:
Fax Number: 
E-mail Address:
SSN or Tax Id: 
          

LENDER INFORMATION 

Full Names of Lender(s): 

Mailing Address:

Vesting: 
Make Checks Payable to: 
Phone Number: 
Fax Number:
E-mail Address:
SSN or Tax Id:
          

LOAN INFORMATION

Original Principal Balance: 
Current Principal Balance: 
Interest Rate:  
      fixed 
      variable 
Loan Position:  
      first 
      second 
      third 
Payment Amount:  $
      Interest Only 
      Fully Amortized 
      Partially Amortized 
Late Charge:  $
Total Past Due Late Charges:  $
Describe any impounds: 
Describe any amounts now due: 
Describe any advances made:
Prepayment Penalty, if any: 
          

PROPERTY INFORMATION 

Check if : owner occupied
non-owner occupied 
single family residence
apartment complex
commercial property
vacant land
Property Address: 

County: 
APN: 
The undersigned lender hereby acknowledges by their signature below that the foregoing information is true and correct to the best of their knowledge and belief and further acknowledges receipt of a copy of the foregoing. 
Date: _________________   
 _________________________  
Signature of Lender
__________________________  
Signature of Lender 
          
Complete This Section Only if Ordering New Loan Documents 

 

SERVICE ARRANGEMENTS

Name of Loan Service Company: 
Mailing Address: 

Phone Number:
Fax Number:
Describe insurance requirements:  earthquake
flood
other:
Name of Title Company:
Name of Escrow Officer :
Title Company Address: 

Title Company Phone No.:
Title Company Fax No.:
Select type of title policy: ALTA
CLTA
Other: 
Check if  Loan is funded with broker controlled funds
Include sample waiver of 3 day right of rescission
Loan is Section 32 (contact CJIS, Inc. for separate required worksheet)
Check if provided to Lender: copy of the appraisal or broker’s opinion of value
copy of the preliminary title report 
copy of the lender/purchaser disclosure statement 
service agreement
credit report
other
          

LOAN COSTS

 
Include in APR?
Escrow Fee: 
$
Credit Fee: 
$
Notary Fees: 
$
Appraisal Fee: 
$
Doc Prep: 
$
Title Policy: 
$
Inspections: 
$
Recording: 
$
Processing: 
$
Pro-rated Interest: 
$
Other:
$
Total Loan Costs to Borrower:  $
          

 DISBURSEMENTS FROM LOAN PROCEEDS

Commission to Originating Broker:  $
Commission to Referring/Cooperating Broker:  $
Estimated Loan Costs (total from above): $
Property Taxes: $
Insurance Premiums:  $
Reconveyance Fees: $
Payoff to:
Payoff to:
Pay to:
Pay to:
Amount paid to or due from borrower:  $
Total Disbursements:  $
The undersigned broker hereby requests borrower loan documents and investor disclosure statements for the transaction as specified above and agrees to the terms and conditions as set forth in the Contract for Services. 
Date: __________________
__________________________________________________  
Signature of Broker
         

 
 

  
 
 
  

 
1998-2015 CJ Investment Services, Inc.