Commission Split Authorization Form
This form must be completed and signed in order for the commission split to be properly
authorized. An original signed copy of this form must be submitted to Agent Mortgage
payroll department prior to the loan closing. A completed copy of this form must be
given to all parities involved in the commission split for their record keeping. Use either a
percentage or a flat dollar amount, but not both for the same individual. One individual
can have a dollar amount while another individual can have a percentage.
Loan Number ______________________________
Borrower’s Name ____________________________________________________________________
Address of Property being mortgaged ____________________________________________________
___________________________________________________________________________________
Primary Loan Officer’s Name __________________________________________________________
Primary Loan Officer’s Social Security # _________________________________________________
Primary Loan Officer’s Signature _______________________________________________________
Secondary Loan Officer’s Name ________________________________________________________
Secondary Loan Officer’s Social Security # ________________________________________________
Secondary Loan Officer’s Percentage Split ___________________ or $ amount __________________
Secondary Loan Officer’s Signature _____________________________________________________
Primary Loan Partner’s Name __________________________________________________________
Primary Loan Partner’s Social Security # _________________________________________________
Primary Loan Partner’s Percentage Split ________________ or $ amount _______________________
Secondary Loan Partner’s Name ________________________________________________________
Secondary Loan Partner’s Social Security # ________________________________________________
Secondary