Affiliated Business Arrangement Disclosure


This is to give you notice that Mutual of Omaha Bank has a business relationship with Synergy One Lending, Inc. (“Synergy”), a wholly owned subsidiary of Mutual of Omaha Bank, which at times conducts business as Retirement Funding Solutions (“RFS”) and Mutual of Omaha Mortgage. Because of this relationship, this referral may provide Mutual of Omaha Bank a financial or other benefit.

The estimated charges for the origination or refinance of your mortgage loan by Synergy, RFS or Mutual of Omaha Mortgage is set forth below. You are NOT required to use Synergy, RFS or Mutual of Omaha Mortgage as a condition for purchase or refinance of your property. THERE ARE FREQUENTLY OTHER SETTLEMENT SERVICE PROVIDERS AVAILABLE WITH SIMILAR SERVICES. YOU ARE FREE TO SHOP AROUND TO DETERMINE THAT YOU ARE RECEIVING THE BEST SERVICES AND THE BEST RATE FOR THESE SERVICES.

Synergy/Mutual of Omaha Mortgage
Underwriting Fee: $412.00 - $687.00                       Processing Fee:  $480.00 - $830.00

Origination Fee: $500-$6,000 based on rate and margin 


By checking this box, I have read this disclosure form, and understand that Mutual of Omaha Bank is referring me/us to purchase the above-described settlement service(s) and may receive a financial or other benefit as the result of this referral. Please print or download this disclosure for your records.