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  Are you a BROKER?

 Name & Co.     Phone #s    E-Mail

 Borrower Information

  Last Name *      First Name *  

  Res Address *   City *   St *   Zip *

  Main Phone Contact    1 *        Phone 2 

  Occupation *      # Yrs *          Annual Income * $

  Main Contact Email *     Double Check Please!

  Credit Rating  *    Excellent, Good, Fair, Poor

  Co-Borrower

  Last Name      First Name 

  Res Address    City   St.  Zip

  Phone 1        Phone 2 

  Occupation      # Yrs.      Annual Income  $     

  Credit Rating      Excellent, Good, Fair, Poor

  Title to be held as:
  Individual(s)       
  Corp or LLC  Corp/LLC Name, Address and Start Date:

  Credit Comments Borrower and Co Borrower
  Please give a short explanation if credit rated less than "Good". Enter scores if known.
 

  Subject Property Information

  Purpose of Loan *                         Please Choose One Purchase Commercial Property Refinance With CASH OUT Refinance - NO CASH OUT Land Acquisition-Development Business Loan - NO Real Estate   

  Est. Real Estate Value * $     (Not including business value)

  Purchase or Contract Price  $   (For New Purchases Only)

  Loan Amount Requested *  $              

  IF FOR PURCHASE - Down Payment Available  $

  Do you need a STATED or No INCOME QUALIFYING loan?  NO     YES

  Subj. Property Address  if known

  TYPE OF BUSINESS / PROPERTY *
  IE: Mixed Use, Office, Warehouse, Auto Shop, Car Wash, Retail, Laundromat, Motel, Restaurant, Multi-Family 5+ units, B&B. etc.

  EXPERIENCE in subject industry (if any)   BRIEF EXPLANATION.

  Number of Buildings             If Mixed Use - Describe  

  Square Footage - Building  est.           Lot Size  est.

  For Multi-Family Units:
  No. of Units            % Of Units Occupied 

  Occupancy Type:
  Business Owner Occupied / Operated 
  Business Investment For Rental to Operators
  Management contract - Manager employed by owner.

    For Refinances:

  Original Cost $        Date Purchased   

  Current Loan Bal.$    Current Rate  %   Current Pymt.   

  Prepay Penalty   $ Enter $ amount if applicable.

  Purpose of REFINANCE:   IE: lower rate/pymt, balloon note due, need cash, get fixed rate etc.

  Amount Of Cash Out Requested (If Applicable)  $

  Purpose For Cash Out ( If Applicable ): 

   Additional Information that may help us help you.
 

   Additional Details Of Loan Purpose - List Any Other Liens or Info Here:
   

  What search engine, website or person referred you to us?  

Call 1-800-938-3668 if trouble with form.

What Year Is It?            Why is this asked? SPAM control of robot form submission.