Ind. Admin. Code tit. 710, r. 1-22-5 – Forms

Sec. 5. Within three (3) business days of the time an application for a loan is made to a licensee, the licensee must have entered into a separate, signed, and written loan broker agreement with the potential borrower. A copy of the agreement shall be given to the potential borrower, and the original shall be placed in the file of the borrower or proposed borrower required under IC 23-2-5-18(a)(1)(B) [ IC 23-2- 5 was repealed by P.L.175-2019, SECTION 1, effective July 1, 2019. See IC 23-2.5.]. The agreement shall contain, at a minimum, the following:

(1) The name of the licensee.
(2) The Indiana loan broker license number of the licensee.
(3) The name of the prospective borrower.
(4) The date of the agreement and the period for which it shall remain in effect.
(5) A statement that the licensee is not the credit provider.
(6) A complete description of the services the licensee undertakes to perform for the prospective borrower.
(7) A specific statement that the licensee cannot solicit or collect any fee, other than a bona fide third party fee, prior to the loan closing.
(8) An estimate of the costs of the licensee's services, which may be expressed as a specific dollar amount or percentage or as a range, disclosing the factors used in determining the fee within that range, together with the maximum cost of services, along with a statement that the amounts are not due unless and until the loan closes. The amounts shall include all compensation paid to the licensee whether paid directly or indirectly, including any applicable yield-spread premium.
(9) The following disclosure in clear and legible print:
1. (Name of licensee) IS LICENSED UNDER THE LAWS OF THE STATE OF INDIANA AND BY STATE LAW IS SUBJECT TO THE REGULATORY OVERSIGHT BY THE INDIANA SECRETARY OF STATE'S SECURITIES DIVISION. ANY CONSUMER WISHING TO FILE A COMPLAINT AGAINST OR INQUIRY REGARDING THE REGISTRATION STATUS OF (Name of licensee) SHOULD CONTACT THE SECURITIES DIVISION THROUGH ONE OF THE MEANS LISTED BELOW:
  1. BY U.S. MAIL:
    1. 302 W. WASHINGTON ST.
    2. ROOM E-111
    3. INDIANAPOLIS, IN 46204
  2. BY TELEPHONE:
    1. 1-800-223-8791
  3. BY INTERNET:
    1. http://www.in.gov/sos/securities/index.html

(Securities Division; 710 IAC 1-22-5; filed Jan 19, 2006, 12:19 p.m.: 29 IR 1925; readopted filed Nov 26, 2012, 1:59 p.m.: 20121226-IR-710120573RFA; readopted filed Nov 19, 2018, 12:53 p.m.: 20181219-IR-710180415RFA; readopted filed Nov 26, 2024, 2:55 p.m.: 20241225-IR-710230842RFA)