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Section A - General information

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

Credit Rating

Credit Score

Employer

Title/Position

Self Employed

Years in Profession

Start Month

Start Year

Monthly Salary

Other Income

Section B – Real Estate Investment Experience

How many investment properties have you sold after rehabbing them (Fix and Flip)? 

How many investment properties have you rehabbed and held(Fix and Hold)? 

Number of Investment properties sold without rehabbing them(Wholesale)?

How many investment properties do you currently own? 

Total number of real estate investment transactions?

Last three (3) documented investment properties sold:

Date Purchased LLC Name Property Address Acquisition Price Construction Cost Sale Price Date Sold

Property 1

Date Purchased

LLC Name

Property Address

Acquisition Price

Construction Cost

Sale Price

Date Sold

Property 2

Date Purchased

LLC Name

Property Address

Acquisition Price

Construction Cost

Sale Price

Date Sold

Property 3

Date Purchased

LLC Name

Property Address

Acquisition Price

Construction Cost

Sale Price

Date Sold

Section C – Funding Sought & Transactions

Investment Property Address

Amount of financing requested

Cash available for down payment

Loan Purpose

Purchase price

Construction costs

After repair value

Exit Strategy

Number of units

Months from purchase date until construction complete

Months from construction complete to sale date

No. of such projects you will do at a time

Name of Wholesaler(if applicable)

What is the wholesale fee?

Section D –Personal Financial Statement

Employer / Business Name:

Office Phone:

Employer / Business Address:

City:

State:

Zip Code:

Assets Dollars Cents
Cash and Checking
Saving
Stocks/Bonds
Retirement (401k, IRA)
Other Investments
Real Estate - Schedule A & B
Loans Receivable
Other Personal Property
Automobiles
Other Assets
TOTAL
Liabilities Dollars Cents
Notes Payable-Banks-Secured
Mortages Payable-Schedule A & B
Automobiles
Crdedit Cards
Education
Unpaid Income Tax
Other
TOTAL

Are all bad and doubtful assets excluded from this statement?  yes no

If No, Explain:

Income taxes settled thought what date?

Additional assets $:

Additional Sources of Income

Salary, Bonuses & Commissions

Dividends

Real Estate Income

Other Income

Total

Personal Information

Do you have a will?  Yes No

If yes, name the executor

Are you a partner or officer in any other venture?

Are you Single or Married?  Single Married

What is your Age

How many minor children do you have

Other Dependents

General Information

Have you ever had a foreclosure  Yes No

If Yes, Explain

Are you a defendant in any suits or legal actions?  Yes No

SCHEDULE A - PARTIAL INTERESTS IN REAL ESTATE EQUITIES