Name
Address
City
State
Zip Code
Home Phone
Work Phone
Email
Please contact me by Email AddressHome PhoneWork Phone
Best Time to Reach me Morning 10:00 AM to 11:00 AMAfter Noon 12:00 PM to 18:00 PMEvening 18:00 PM to 20:00 PM
Occupation
Annual Income Less than $25,000$25,000 to 50,000$50,000 to 75,000$100,000 to 150,000$150,000 to 250,000$250,000 to 500,000more than $500,000
Credit Status more than 800799 to 700699 to 600599 to 500499 to 400In BankruptcyBankruptcy discharged within 3 yearsOther I will explain in comment area
Any foreclosures, bankruptcies, leins, or judgements?* YesNo
Approx Property Value
Is the property a monthly rental? If so, what’s the rental YesNo
Lot Size Square Footage
Property Address
Property Purchase Price
Purchase Date Now or Less than year1 year ago2 years ago3 years ago4 years agoMore than 5 years ago
Structure Square Footage
What’s the rental income?
Year Built
Current or Past due CurrentPast Due
Monthly Payment
Interest Rate
Original Balance $
Present Balance (if none type “0”) $
Term
Current Past due YesNo
Monthly Payment $
Present Balance $
Amount of Cash Down Payment (if purchase)
Amount of Loan Requested
Amount of Seller Carryback (if applicable)
Additional Information / Comments
Purpose of Loan PurchaseMaturing Loan – No Cash outMaturing Loan — Cash outCash out RefinanceRennovation or expansionInvestmentBillsBusiness PurposesOther
Requested Loan Type First MortgageSecond MortgageThird Mortgage
Term Desired 1 Year2 Years3 Years4 Years5 Years6 Years7 Years8 Years9 Years10 Years
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