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Borrower Information * required

First Name (required)

Middle Initial(required)

Last Name (required)

Date of Birth (required)

SSN (required)

Your Email (required)

Mobile Phone

Home Phone (required)

Work Phone

Contact Method

Street

City

State

Zip

Broker's Name

Number of Principals, Including you

Credit Score

Deal Information

Investment Property Address

Investment Property City

Investment Property State

Investment Property Zip

Loan Purpose

Loan Type

Loan Amount Requested

Purchase Price

Estimated Construction Cost

After Repair Value

Property Taxes

Number of Units

Timeline: Purchase Date to Completed Construction

Timeline: Purchase Date to Sale Date

LLC/ Entity Information

LLC/ Entity Name

EIN#

Entity Address

Entity City

Entity State

Entity Zip

Type of Entity

Employment Information

Employer

Employer Phone

Employer Address

Employer City

Employer State

Employer Zip

Title/Position

Self Employed

Years in Profession

Start Month

Start Year

Monthly Salary

Other Income

Total Income

How did you hear about us?

Real Estate Investment Experience

How many investment properties have you sold after rehabbing them?

How many investment properties have you rehabbed and held?

Number of Investment properties sold without rehabbing them (i.e., wholesaling)?

How many investment properties do you currently own?

Total number of real estate investment transactions?

Last three (3) documented investment properties sold:

Property A

Investment Property Address?

Purchase Date

Purchased by (LLC/Entity Name)?

Purchase Price?

Construction Cost?

Sale Price

Sale Date

Property B

Investment Property Address?

Purchase Date

Purchased by (LLC/Entity Name)?

Purchase Price?

Construction Cost?

Sale Price

Sale Date

Property C

Investment Property Address?

Purchase Date

Purchased by (LLC/Entity Name)?

Purchase Price?

Construction Cost?

Sale Price

Sale Date

Personal Financial Statement

Personal Assets:

Cash on Hand & Checking Account(s)

Savings Account(s)

Business Account(s)

Life Insurance - Cash Surrender Value Only

Stocks & Bonds

Real Estate

401K/ IRA Account(s)

Total Assets

Personal Liabilities:

Mortgages on Real Estate

Installment Account (Auto)

Unpaid Taxes

Loan on Life Insurance

Other Liabilities

Total Liabilities

Net Total

Payment Information

Cardholder's Name

Cardholder's Phone Number

Cardholder's E-mail

Billing Address

Billing City

Billing State

Billing Zip

Card Type

Credit Card Number

Expiration Date

Card Security Code