Basic Info
Required Docs
Agent/Broker Info
Are you a Sales Agent /Broker or working with one? Yes No
Borrower Contact Info
How did you hear about us?
Loan Program?
Borrower's first name
Borrower's last name
Email Address
Cell Phone
 -    -  
Home Phone
 -    -   Ext # 
Date Of Birth

Social Security Number
 -    -  
Please select service provider if you would like to receive task reminders via SMS
Marital Status?  Single  Married  Divorced  Widowed
Credit Score Range
Experian Score
Equifax Score
Transunion Score
Is there a Co-borrower?
Borrower Address
Zip Code
Borrower Background
Are you a U.S. Citizen? Yes No
Has the borrower been declared bankrupt within the past 7 years? Yes No
Are there an outstanding judgements against the borrowers? Yes No
Do you have any active lawsuits against you? Yes No
Have you had or currently have any property tax liens? Yes No
Has the borrower directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? Yes No
Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee Yes No
Have you ever been convicted of a felony or other fraud related crimes? Yes No
Background Explanation
Borrower Experience
Do you have any real estate investment flipping experience?
Yes No NA
Do you have ground up construction experience?
Yes No NA
Do you have any projects currently in progress?
Yes No NA
Do you own investment properties?
Yes No NA
Are you a member of an investment club or group?
Yes No NA
Borrower Monthly Income
Employment Type   
Monthly Income $
Borrower Monthly Expenses

Monthly Payment

Balance Owed

Existing mortgages and
$ $
Installment Loans $ $
Credit Cards $ $
Student Loans $ $
Alimony/Child Support $ $
Other $ $

Total Household Expenses

$ 0.00

Assets (Include Borrower + Co-borrower amounts if any)
Type $ Estimated Value $ Amount Owed
Cash $  
Checking Account(s) $  
Net worth of business(es) owned $    
Saving / Money Market $  
Stocks / Bonds / CDs $  
IRA / Keogh Accounts $  
401k / ESPO Accounts $  
Life Insurance (Whole Life not Term) $  
Home $ $  
Other Real Estate $ $
Cars $ $
Other $ $
Other (Description)   





Total Estimated Value

- Total Amount Owed

= Total Net Value

$ 0.00

-   $ 0.00

=   $ 0.00

Business Entity
Are you borrowing under an Entity? Yes No
Property Details
Zip Code
Present Occupancy
Property Type
Property Condition
Loan Terms
Loan Purpose    Borrower Occupancy   
Type of Purchase   
Loan Term    Lien Position   
Will the property need repairs, rehab, or construction?
Yes No
Is this loan being cross collateralized?
Yes No
Acquisition / Purchase Price Assessed As-is Value
Acquisition Price Financed
$ 0.00
Acquisition Down Payment
Down Payment %    
Total Initial Loan Amount
$ 0.00
Acquisition LTV   0.00 %
Market LTV   0.00 %
Additional Questions
Is there an accepted purchase agreement? Yes No Will borrower personally guarantee this loan? Yes No
Will there be a 2nd lien or borrowed money for down payment? Yes No
Does the borrower intend to occupy the property as their primary residence? Yes No  
Exit Strategy
Is the property subject to any additional liens, encumbrances, or restrictions? Yes No
Exit Strategy Explanation
Attorney Info
Attorney Name  
Attorney Firm Name
Attorney Phone  -    -   Ext # 
Attorney E-mail
Insurance Company info
Insurance Rep First Name  
Insurance Rep Last Name
Name of Carrier
Phone  -    -   Ext # 

Borrower Notes / Comments

Terms And Conditions

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