Quick Application Form

What kind of program are you looking for?

Lead Source

2nd Guarantor Information

Credit Score Range

Mid Fico Score

Mobile Service Provider

Yes No

Personal Guarantor Experience

Does the guarantor have Fix & Flip or Buy & Hold experience?

Yes No

# of years of experience?

# of properties completed in last 36 months

Property Type

Purchase date

Purchase Price

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Property Type

Purchase date

Purchase Price

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Property Type

Purchase date

Purchase Price

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Yes No

Property Type

Purchase date

Purchase Price

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Property Type

Purchase date

Purchase Price

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Property Type

Purchase date

Purchase Price

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Yes No

Property Type

Purchase date

Purchase Price

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Property Type

Purchase date

Purchase Price

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Property Type

Purchase date

Purchase Price

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Yes No

How much liquid assets does guarantor currently have?

2nd Guarantor Experience

Assets (Include Borrower + Co-borrower amounts if any)

Type

Estimated Value ($)

Amount Owed ($)

Total cash in bank accounts

Total value of retirement accounts

Home

Secondary Residences

Other Real Estate

Total:

$

Total Est. Value

- Total Amt Owed

= Total Net Value

$

- $

= $

Business Entity

Do you have a business entity created for this transaction?

Yes No

Members/Officers

(If borrower does not own 100% of entity, list additional members/officers)

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Drivers License

Drivers License State

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Drivers License

Drivers License State

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Drivers License

Drivers License State

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Drivers License

Drivers License State

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Drivers License

Drivers License State

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Drivers License

Drivers License State

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Drivers License

Drivers License State

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Drivers License

Drivers License State

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Drivers License

Drivers License State

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Drivers License

Drivers License State

VENDOR & EQUIPMENT INFORMATION

1 )Vendor Name

Vendor Phone

Vendor Contact

Equipment Type

Vin or Serial Number

Year

Sale Price

New Used

Make

Down Payment

Replacement Addition

Model

Loan Amt. Requested

Quantity

Mileage

Equipment Description

Term

Options

Loan Terms

Desired Closing Date

Yes No

$

Include All

%

Tell us more about the deal, your background & why you need this loan?

Terms And Conditions

First Rehab Lending, LLC (the “Company”) and its affiliates, offers this website (the “Site”) and the Loan Application Form and Broker Contact Form (collectively referred to as the “Forms”) subject to the following terms and conditions (hereinafter referred to as the “Agreement”). By using the Forms, you are accepting the terms and conditions contained herein.

The Forms are provided merely as an invitation for information to be submitted. Use of the Forms should not be construed as creating a lender-borrower or lender-broker relationship between you and the Company or its Affiliates and should not be construed as creating a commitment to lend on the part of the Company or it Affiliates. The Company and its Affiliates do not guarantee that information submitted will be reviewed nor does it guarantee that a representative of the Company or its Affiliates will contact you regarding your submission.

You acknowledge that the Company and its Affiliates may provide your information to other trusted companies providing services or products similar to, or complementary with, your requested services or products, so long as those parties agree to keep your information confidential. The Company and its Affiliates may use the site services offered (“Affiliate Website”) to help you find similar or complementary services or products. Your use of this Site or the Forms constitutes your acceptance of the terms of use for the Affiliate Website, which terms of use incorporated herein by reference.

By using the Forms, you are certifying that your submission is not prohibited by any confidentiality obligations, employment agreement, or similar contractual obligation. You expressly agree and acknowledge that the information submitted is truthful and does not contain misleading or false statements. You further agree and acknowledge that you have proper authorization to submit the Form and discuss its contents with the Company and its Affiliates, the Company’s or its Affiliates’ employees, and/or the Company’s or its Affiliates’ representatives.

By using the Forms and submitting the information, you represent and warrant that you own or otherwise control all of the rights to the content that you provide (or if you are acting on behalf of an entity, that you have the authority to submit the information), that the content is accurate, and that it does not violate the terms of this Agreement. You grant the Company and its Affiliates a royalty-free, perpetual, irrevocable, non-exclusive right and license to use, copy, modify, display, archive, store, distribute, reproduce and create derivative works from all information you provide, in any form, media, software, or technology of any kind now existing or developed in the future. Without limiting the generality of the foregoing, you authorize the Company and its Affiliates to include the information in a searchable format that may be accessed by the Company and its Affiliates. You also grant the Company and its Affiliates the right to use your name and other information that you provide in connection with its use and with the reproduction or distribution of such material. All rights in this paragraph are granted without the need for additional compensation of any sort to you.

To the fullest extent permitted by law, the Company and its Affiliates excludes all representations and warranties relating to use of the Forms. To the fullest extent permitted by law, the Company and its Affiliates excludes all liability for damages arising out of or in connection with your use of the Forms. This includes, without limitation, direct loss, loss of business or profits, whether or not the loss of such business or profits was foreseeable, arose in the normal course of business, or whether or not you advised the Company or its Affiliates of the possibility of such potential loss.

In the event that any provision of this Agreement is found invalid or unenforceable by a court of law or other appropriate authority, the invalidity or unenforceability of such provision shall not affect the other provisions of this Agreement which shall remain in full force and effect.

This Agreement shall be deemed to have been made and shall be governed by the laws of the State of New York, U.S.A., except for patents, trademarks and copyrights, which shall be governed by and under the applicable patent, trademark and copyright laws.

By using the Forms or any product, service, or functionality originating from your use of the Website (defined herein) or services offered by the Company and its Affiliates, you are allowing the Company and its Affiliates to share information with any third parties with whom the Company and its Affiliates have a pertinent contractual relationship—any information necessary to facilitate its provision of products, services, or functionality to you.

The Company and its Affiliates reserves the right to change the terms, conditions, and notices under which this website is offered. The Company and its Affiliates shall have the right, at its discretion, to change, modify, add or remove terms of this Agreement at any time without notice. Changes shall be effective immediately. You agree to review this Agreement periodically. Your use of this website or the Forms constitutes your continued acceptance of the terms and conditions of this Agreement.

By using these forms, you hereby unconditionally and irrevocably waive any and all right to trial by jury in any action, suit counterclaim or cross claim in connection with out of or otherwise relating to the use of the forms. The website any transaction arising therefrom or relating thereto or any dispute involving you and the company First Rehab Lending.

By agreeing to the Terms you are allowing First Rehab Lending to pull your credit authorization. To all consumer-reporting agencies and to all creditors and depositories of the undersigned:
Please be advised that the undersigned, and each of them, has made application to: First Rehab Lending 
Requesting an extension of credit to the undersigned. Therefore, the undersigned, and each of them, hereby authorizes you to provide credit report and/or a disclosure to Lender or any agent or assignee. The undersigned also authorizes you to disclose your deposit or credit experiences with the undersigned to Lender or to third parties.

In addition, the undersigned, and each of them, hereby authorizes Lender to disclose to any third party, or any agent or employee thereof, information regarding the deposit or credit experience with any of the undersigned.

A photographic or carbon copy of this authorization bearing a photographic or carbon copy of the signature(s) of the undersigned may be deemed to be equivalent to the original hereof and may be used as a duplicate original.

By checking this box I agree to the terms and conditions. *