MORTGAGE BENEFIT ENROLLMENT FORM

• Denotes Required Information

Personal Information

First Name
Last Name
E-mail address
Job Title

Company Information

Company Name
Address 1
Address 2
City
State
Zip Code (e.g. 12345)  
Work Phone
Website URL
Total Number of Employees  
  I, the applicant, possess authority to render executive decisions on behalf of the above stated company in terms of enrollment in employee benefit programs.
 
Terms and Conditions
The following terms and conditions apply to the Mortgage Benefit Program (the “Program”) of Provident Funding Associates, L.P. (“Provident Funding”):
1. Company shall from time to time in its discretion inform its employees of the Program.
2. Employees shall apply for a mortgage loan by submitting an application to Lender via its website www.provident.com, including with each application a coupon code supplied by Lender to Company.
3. For each such loan application that is approved, Provident Funding shall provide a discount on the loan origination fee that it would ordinarily charge a borrower. Provident Funding may change the amount of such discount or discontinue the Program in its sole discretion, following notice to Company.
4. Company is not obligated to cause any of its employees to apply for a mortgage loan from Provident Funding, and Provident Funding is not obligated to make a mortgage loan to an employee of Company.
5. Company will inform Provident Funding in writing if its number of employees declines to less than 25, in which case Provident Funding reserves the right in its sole discretion to discontinue participation in the Program by Company’s employees.
  By checking this box, I acknowledge on behalf of the Company its agreement to these terms and conditions and that I am authorized to do so as a representative of the Company.