STATE OF MAINE BUREAU OF CONSUMER CREDIT PROTECTION
MORTGAGE BROKER AGREEMENT/CONTRACT

Name of Mortgage Loan Broker
Street Address
Mailing Address
Telephone No.

1.	Agreement of the Mortgage Broker.

A.  Full and detailed description of the services to be performed for the consumer:  __________________
____________________________________________________________________________________
____________________________________________________________________________________

B.  Extent of any guarantees: _____________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

C.  The Consumer is entitled to a full or partial refund under the following conditions: __________________
_____________________________________________________________________________________
_____________________________________________________________________________________

D.  This contract shall remain in effect for the following length of time (after which a refund must be made if services have not been performed): _______________________________________________________________
_____________________________________________________________________________________

2.	Payment by consumer to Mortgage Broker 

A.  The total cost to the consumer, whether paid to the Mortgage Broker, is itemized as follows:  ______________________________________________________________________________________
______________________________________________________________________________________
	
B.  Payment shall be made to each person in the following manner: ________________________________
______________________________________________________________________________________
______________________________________________________________________________________

3.	NOTICE TO CONSUMER:  Do not sign this agreement before you read it.  You are entitled to a copy of this 		agreement.

Dated: ___________________				                    ________________________________________ 
       Mortgage Broker
                                                                                                                    by:  _______________________________________
                                                                                                                    title: _______________________________________
Dated: ___________________					        ________________________________________
       Consumer
       ________________________________________
Rev. 09/2012  									                     Consumer