Section A - General information
Borrower Information * required
First Name (required)
Last Name (required)
Date of Birth (required)
Your Email (required)
Home Phone (required)
Contact Method ----Mobile PhoneHome PhoneWork Phone
Self Employed ----YesNo
Years in Profession
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:
Section C – Funding Sought & Transactions
Investment Property Address
Amount of financing requested
Cash available for down payment
After repair value
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:
Employer / Business Address:
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
Real Estate Income
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
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