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Salvation Processing, Inc. Submitting Broker: ________________________________________________ L/O Name: ___________________________ Date __________________ Phone _____________________ Fax _____________________ Borrower Name: __________________________________________________ Address: ________________________________________________________ Loan Type (Circle) Conventional FHA VA 2nd / HELOC Loan Purpose (Circle) Purchase Refinance Rate & Term Cash-out Loan Amount: _______________ Term: __________ Int. Rate: _______% Estimated Value: _____________ LTV: ______% CLTV (2nd): ______% LENDER __________________________ PROGRAM # ________________ Contact (Acct. Ex.) _________________ Phone _____________________ ________________________________ _________________________________ Phone _____________________ Phone _____________________ Termite Company: Fax _____________________ ________________________________ Order # ____________________ Phone _____________________ ________________________________ _________________________________ Phone _____________________ Phone _____________________ Fax _____________________ Fax _____________________ |