Referral Source
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
Borrower Experience
Yes No

List 3 examples of past deals:

Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Entity Name
Ownership %
Exit
Address
City
State
Zip
Upload HUD
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Entity Name
Ownership %
Exit
Address
City
State
Zip
Upload HUD
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Entity Name
Ownership %
Exit
Address
City
State
Zip
Upload HUD
Yes No
Yes No

List 3 examples of past deals:

Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Entity Name
Ownership %
Exit
Address
City
State
Zip
Upload HUD
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Entity Name
Ownership %
Exit
Address
City
State
Zip
Upload HUD
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Entity Name
Ownership %
Exit
Address
City
State
Zip
Upload HUD
Yes No

List 3 examples of past deals:

Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Entity Name
Ownership %
Exit
Address
City
State
Zip
Upload HUD
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Entity Name
Ownership %
Exit
Address
City
State
Zip
Upload HUD
Property Type
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Entity Name
Ownership %
Exit
Address
City
State
Zip
Upload HUD
Yes No
Yes No
Yes No
Yes No
Yes No
Loan Request
to
to
to
to
to
to
to
to
to
Assets (Include Borrower + Co-borrower amounts if any)

Type

Estimated Value ($)

Amount Owed ($)

Total:

$

$

Total Est. Value

- Total Amt Owed

= Total Net Value

$

- $

= $

Business Entity
Yes No
 

VENDOR & EQUIPMENT INFORMATION
 
Attorney Info
Insurance Company Info
HMDA - (Borrower)
Yes No NA
Hispanic or Latino Not Hispanic or Latino
 American Indian  Asian
 Black or African American
 Native Hawaiian or Other Pacific Islander
 White
Male Female
Borrower Employment Information
I have ownership share of less than 25%
I have ownership share of 25% or more
Weekly   Monthly   Every 2 weeks   Twice a month

Employer Information


Additional Employment Information

Borrower Monthly Income
$
$
$
$
$
$

$

(Borrower)
Borrower Monthly Expenses

Monthly Payment

Bal Owed

$
$
$
$
$
$
$
$
$
$
$

$

(Borrower)

Billing/Payment Information

Check:

Account and Bank Info
Personal Checking
Personal Savings
Business Checking

Credit Card:

Credit Card info
Tell us more about the deal, your background & why you need this loan?
Terms And Conditions

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