Name:

Day Phone:

Eve Phone:

Email Address:

Amount Requested:

Property City:

Property State:

Type of Property:

Apartment Retail Office Warehouse Industrial Other

Purpose of Loan:

Purchase Refinance

Description of Property:

Estimated Value:

If Purchase:

Purchase Price:

Down Payment:

If Refinance:

Date purchased:

Purchase price:

Mortgage balance:

Lender name:

Interest rate:

Loan maturity date:

Total Number of Units if
Multi-Tenanted:

#Apts:

#Stores:

#Office:

Is property Owner Occupied? If yes, what %:

Any vacancy? If yes, what %:

What is condition of property? Describe work needed.

How is your personal credit rating? (Excellent, Good, Fair, Poor)

Excellent Good Fair Poor

Do you know your credit score?

Any bankruptcy, judgments, major delinquency? If so, explain.

Is borrower a US Citizen?

Yes No