* required field
Have you already spoken with a South Beach Lending Agent? * Yes No
Are you currently working with a Realtor or agent? * Yes No
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the Lender's compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. Note that you may select one or more designations for "Race." The law provides that a Lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. If you do not wish to furnish this information, please indicate your preference below by selecting "No".
Each applicant specifically ackknowledges and agrees that: