Loan Officer/Mortgage Broker 
Yes No
Borrower Info

Yes No
Mailing Address


Personal Info
 Unmarried  Married  Separated
 U.S. Citizen  Perm Resident Alien  Non-Perm Resident Alien
Yes No
 Currently serving on active duty
 Currently Retired, discharged, or separated from service
 Non-activated member of the Reserve or National Guard
 Surviving Spouse
Borrower Background
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
SBA Questions
$

$
Payroll Rent/Mortgage Interest
Utilities Other
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
$
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No
Yes No

Schedule of Real Estate Owned and Sold
Yes No
Yes No
Business Entity
Yes No

  General Business Info

 

  Location/Property Details


Urban Rural Suburban
$
$

  Business Details

Service Product
B2B B2C
Yes No
Yes   No
Yes No
Yes No
Yes No

  Business Financials

$
$
$
$
$

Members/Officers

(List all members with 20% ownership or more.)
Same as Borrower/Applicant Info Above
   
%
Add More Members/Officers Info
Subject Property Details

  Property Location

Urban   Rural Suburban

  Property Characteristics

 Yes      No

  Property Details

In Month

  Property Access

Yes No
Foreclosure / Default Info
 Yes  No  NA
 Yes  No  NA
 Yes  No  NA
 Yes  No  NA
Attorney Information
 
Trustee Information
 
Loan Workout Q & A
Yes No NA
Yes No NA
Yes No NA
Yes No NA
Yes No NA
Yes No NA
Yes No NA
Yes No NA
$
Yes No NA
$
Yes No NA
Yes No NA
$
Yes No NA
Yes No NA
Yes No NA
Yes No NA
Yes No NA
Yes No NA
1st Lien Current Mortgage Scenario
$
$
Monthly Payment Details
$
$
$
$
$
$
$
$
$
$
$
$
Rep Name & all other contact info....
2nd Lien Current Mortgage Scenario
$
$
$
Rep Name & all other contact info....
VENDOR & EQUIPMENT INFORMATION
 
Loan Terms
$

%
%
%
Yes No
 Current Loan Balance
 Total Loan Amount     
 Set Manual Payment
$ 0
Yes No
Yes No
Yes No
$
$

$


$
$
$

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Subject Property Cash Flow (Annualized) 
$
 
$  
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$  
 
$
 
$  
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$  
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Additional Questions
Yes No
Yes No
Yes No
$
Yes No
Yes No
Yes No
Yes No
$
Yes No
$
Yes No