Point of Loan Origination (POLO) Application

This application form provides us the information we need to best apply our efforts in assisting you. Someone from our organization will reach out to you after you submit the required information.

*Indicates a required form field.

Finance Company

Address

City

State/Province

Zip/Postal Code

Office Phone

Office Fax

Contact Person

Name

Phone

Details

Average number of new BHPH deals per month

Current number of BHPH notes

Average ACV at the time of sale

Average loan amount

Average number of repos per month

DMS

Enter full name of submitter

Date

Survey

How did you hear about us?

Agent Referral

Conventions

Internet Search

Letter/Mailer

Other (specify below)

If through Agent Referral, which one?

If through a Convention, which event?

Or, what other source brought you to us?

Point of Loan Origination (POLO) Application

Berkshire Risk Services