New Entity Input Form - TaliMar Financial

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Are you the Borrower or Broker?

Are you working with an Account Representative? *

Select the name of your Account Representative? *

Enter Name

Name *

First

Last

Enter name of individual completing this form.

Phone *

Email *

Are you a signer on the loan? *

Borrower Information

Is this an Account Application being completed for a Sub Entity? *

Enter Borrower Name for the Sub Entity *

If this application is being completed for a Sub Entity, enter the Sub Entity information below.

Selection Ownership Type of Property *

Trust
LLC / LP / GP
Corporation
401K / IRA

Enter Name of Entity or Trust *

Is there a custodian involved? *

Enter the name of the Custodian *

Enter Phone Number for Custodian *

Enter Date of Trust *

Enter State of Formation *

Enter Mailing Address of Entity / Trust *

Address Line 1

Address Line 2

City

State

Zip Code

Enter Tax ID # of Entity / Trust *

Is the Entity in Good Standing *

Explain *

Signer Information

Enter the contact information for each signer on the loan that meet the following criteria: (1) If purchasing as an individual(s), enter spouse, partner, etc. (2) If in an entity such as an LLC, Corp, LP, etc. enter all owners with a 20% interest or greater, (3) If a guarantor on the loan.

Enter Name for Signer *

First

Last

If an Entity, all members with a 20% or greater ownership must be listed as a signer.

Enter e-mail for Signer 1 *

Enter % Ownership for Signer 1 *

Is there another signer? (2)

Enter Name for Signer 2

First

Last

If an Entity, all members with a 20% or greater ownership must be listed as a signer.

Enter % Ownership for Signer 2

Enter E-Mail Address for Signer 2

Is there another signer? (3)

Enter Signer 3 Name

First

Last

If an Entity, all members with a 20% or greater ownership must be listed as a signer.

Enter E-mail Address for Signer 3

Enter % Ownership for Signer 3

Is there another signer? (4)

Enter Signer 4 Name

First

Last

If an Entity, all members with a 20% or greater ownership must be listed as a signer.

Enter E-Mail Address for Signer 4

Enter % Ownership for Signer 4

Is there another signer? (5)

Enter Signer 5 Name

First

Last

If an Entity, all members with a 20% or greater ownership must be listed as a signer.

Enter E-Mail Address for Signer 5

Enter % Ownership for Signer 5

Is there a Sub-Entity for this Entity?

How did you hear about TaliMar Financial? *

Please Explain. *

Please provide the name of who referred you TaliMar Financial. *

At TaliMar Financial, we are committed to protecting the privacy and security of your personal information. We do not sell or distribute any personal or financial information to third parties for marketing or other commercial purposes. However, to facilitate the administration and servicing of loans, we may share necessary borrower information with a third-party loan servicer that complies with all applicable California consumer protection laws. This servicer is required to adhere to strict confidentiality and data protection standards to ensure the security of your information. By selecting Acknowledge, you consent to the limited sharing of your information for the sole purpose of loan servicing. I acknowledge that I have read and understand this notice. I consent to the limited sharing of my personal and financial information with a qualified loan servicer as described above.

Acknowledge

Signature *

Clear Signature

I/We fully understand that is is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Seciton 1001, et. seq.