E-Signature: Request for Amendment to Broker Agreement

If you are an approved Partner with QLMS and would like to be approved to use E-Sign Technology, please complete the information below. Upon completion, our Credit Risk Team and your QLMS Account Executive will be notified, and you will soon after receive a pre-filled Amendment to Broker Agreement via email. This form will allow you to opt in for the use of electronic records and signatures.

Select your Account Executive*

Choose your E-Signature provider*

Partner Legal Name*

Bank NMLS Number*

Contact Name*

Partner Email*

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