PennyONE Application                                                               (Please fill out completely) Please provide all the information below for all the parties to your transaction. Once we receive your application we will send you some additional information and instructions that will guide you through a successful funding. If you have any questions after fully completing this application, please call us at 239-433-2909. PennyONE Acct Rep Submission Date Buyers Name Buyers Phone Number Property Address City, State, Zip Brokerage Company Loan Officer Co. Phone Number LO Cell Phone Number Co. Fax Number LO Fax Number Name of Lender Providing Funds LO Email Address Requested Contribution PennyONE Fee 10% of Contribution or $1,000 whichever is greater plus $195 Processing Fee How much of the requested contribution does the buyer have to bring to closing? Total Amount Seller Will Pay Us (Requested contribution + Fee) Closing Date Form of funds to be sent: (Check one) Check to title Wire to title Wire to buyer Purchase Price Date Funds Are Needed By LTV/CLTV Amount of Seller Paid Closing Costs Has the offer been made? (yes or no) Appraised Value Buyers Agent Buyers Agent Phone # Sellers Agent Sellers Agent Phone # Title Company/Closing Attorney Sellers Name Closing Officer Sellers Phone Number Title Company Phone # Comments: Title Company Fax # Any Additional Contacts: