REFERRAL FORM

For Commercial Loans only in the Tri- State Area

The following information should be completed and provided to Crown Bank when a Realtor/Broker is referring a client interested in applying for a loan with Crown Bank. The Referral Program will provide the Broker/Agent compensation for every client that is referred if & when the loan is closes.

The compensation rate would be as follows:

Loans Up to $500,000 -> $1,500.00

$500,001 - 1,500,000 -> $3,500.00

$1,500,001 - 6,00,000 -> $7,500.00

$6,000,001 - 20,000,000 -> $12,500.00

AGENT/BROKER INFORMATION:

Referring Agent/Broker:

Real Estate Office

Email Address

Address

Phone

Date of Referral

BORROWER INFORMATION:

Name:

Property Address

Phone

Email

TYPE OF LOAN:

Construction Loan:

Commercial Mortgage:

Construction/Permanent Mortgage:

Refinance Existing Commercial Mortgage:

Other:

Loan Amount:

Brief Description of property/project:

Agent/Broker Signature

Borrower Signature

Electronic Signature Disclosure and Agreement

27 Prince Street, Elizabeth, NJ 07208*Ph. 908-659-2100 *Fax 908-289-1601

Email Disclaimer: This is NOT a secured e-mail transmission. Please DO NOT send personal / financial information via this method

By signing this Electronic Signature Disclosure and Agreement, I agree that my electronic signature is legally binding equivalent to my handwritten signature. Whenever I execute an electronic signature, it has the same validity and meaning as my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding. By signing below, I accept the conditions of this agreement..
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AGENT/BROKER INFORMATION:
Referring Agent/Broker:
Real Estate Office
Email Address
Address
Phone
Date of Referral
BORROWER INFORMATION:
Name:
Property Address
Phone
Email
TYPE OF LOAN:
Construction Loan:
Commercial Mortgage:
Construction/Permanent Mortgage:
Refinance Existing Commercial Mortgage:
Other:
Loan Amount:
Brief Description of property/project:
Agent/Broker Signature
Borrower Signature
Electronic Signature Disclosure and Agreement