Are you a BROKER?

 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    ExcellentGoodFairPoorDon't Know

Borrower(s) will be:  Individual(s)   Partnership   Corporation  LLC   

 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 OnePurchase Commercial PropertyRefinance With CASH OUTRefinance - NO CASH OUTLand Acquisition-DevelopmentBusiness 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:
  

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Call 619.287.5555 if you have trouble with this form.