FHA Case Number Assignment Request Form

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Originator Information

Account Executive Name

Bank/Broker Name

Company Name

Tax ID #

Company tax ID #

Borrower Last Name

Loan #

Originator Name

Originator's NMLS Number

Email Address

Case Number Detail

Type of Case

Year Property was Built

If Purchase: Was this case previously sold as Real Estate Owned by HUD?

YESNO

Prior FHA (Forward) Case

If Refinance: Specify type of refinance.

Select Streamline Refinance type

Is this a Cash Out Refinance?

YESNO

Projected Closing Date