Loan Requested by

Company Name

Primary Contact Name

Contact Email

Contact Direct Phone

Contact Fax

Street Address 1

Street Address 2

City

State

Zipcode

Deal Information

Property Type

Property Use

Purpose of Loan

Loan Amount Requested

Current “As Is” Value

Specific Repairs Needed

Estimated Cost of Repairs

After Repair Value (ARV)

How was Value Determined

How Much are You Paying for this Property

Is this Property Under Contract
 Yes  No

Property City

Property State

Property Zip

Borrower Information

How much Borrower Equity (cash) is going into the deal

Total Number of Borrowers

Borrower 1 Credit Rating

Additional Borrower(s) Credit Rating

Does the borrower(s) have additional collateral?

Is the borrower(s) willing to cross collateralize?

Is the borrower(s) willing to cross collateralize?

Explain any Investment or Rehab Experience

Explain any Training, Education, Seminars, etc

Additional Information

How did you hear about us?

Additional Comments