1. Applicant Information

First Name *

Last Name *

Phone Number *

Email Address *

Marital Status *

Single

Applicant Citizenship *

US Citizen

Housing Status *

Own

Rent

Address

Street Address *

City *

State *

Country *

Enter your country

Postal Code *

Has Co-Applicant? *

Yes

Co-Applicant

Full Name

Co-Applicant Number

Co-Applicant Email

Co-Applicant Marital Status *

Single

Co-Applicant City

Co-Applicant State

Co-Applicant Country

Co-Applicant Postal Code

Co-Applicant Citizenship *

US Citizen

2. Entity Information

Entity Name *

Entity Type *

Corporation

Bank Balance

$

EIN

3. Property & Loan Details

Property Address *

Loan Amount *

$

Property Type *

Townhome

Transaction Purpose *

Refinance

Cash-Out Purpose

4. Declarations

Bankruptcy in last 3 years? *

Yes

Lawsuits / Foreclosure? *

Yes

Bankruptcy Detail

Lawsuits / Foreclosure Detail

5. Subject Property & Loan Terms

Occupancy

Owner Occupied

Street Address

Subject Property City

Subject Property State

Zip

Subject Property Type *

Townhome

Loan Amount Requested

$

Loan Term (Months)

6 Months

Loan Product

6. Current Debt (Refinance Only)

Balance Owed

$

Current Lender

Account

Original Cost

$

Date Acquired

Rehab Cost

$

7. Title / Insurance / Closing Agent

Title Company

Company Contact

Company Email

Insurance Carrier

Insurance Carrier Contact

Insurance Carrier Email

Closing Agent Company

Closing Agent Contact

Closing Agent Email

8. Declarations

Are you or your business currently involved, or previously been involved in any pending lawsuits, including foreclosure, collection or suits by past or current lenders, creditors, or subcontractors/suppliers? *

Yes

No

Have you been involved in bankruptcy or insolvency proceedings in the last 3 years? *

Yes

No

Have you been charged or convicted of a felony? *

Yes

No

HaveAre you a licensed General Contractor, Real Estate Broker/Salesperson, Lender, Appraiser, or involved in any other real estate related activities? you been charged or convicted of a felony? (copy) *

Yes

No

Comments / Additional Information