Full Name
*
Phone
*
Email
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Referrer
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Date of Birth
*
Social Security Number
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Your Citizenship? (required for funding)
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U.S. Citizen
Permanent Resident
Are you currently married?
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Yes
No
Select "yes" if divorce is not finalized.
Sex
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Male
Female
Prefer not to say
Race
Leave blank if you prefer not to say.
Estimated Credit Score
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Address
Mailing Address
City
State
Country
Country
Postal Code
Employment Status
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Employer Address
Employer Name
Position or Title
Monthly Income
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Entity Name
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Entity Type
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EIN
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Entity State
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Entity Mailing Address
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Are there multiple members of the entity?
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Yes
No
List members of entity and their ownership percentage.
Do you have a Co-Borrower?
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Yes
No
Co-Borrower Full Name
Co-Borrower Email
Co-Borrower Phone Number
Co-Borrower Credit Score
Co-Borrower Social Security Number
Co-Borrower Date of Birth
Co-Borrower Marital Status
Co-Borrower Citizenship
Co-Borrower Mailing Address
Co-Borrower Employment Status
Co-Borrower Employment Details: salary, company, position
Purchase Contract Expiration Date
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Existing Loan Maturity Date
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Payoff Amount
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$
Requested Closing Date
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Title Company Name
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Title Company Address
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Closing Representative
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Closing Representative Email
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Closing Representative Phone
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You have open or past judgements or tax liens against you.
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True
False
You have open or past foreclosures.
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True
False
You have been convicted of a felony.
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True
False
You or any officer of your company or any guarantor have been involved in bankruptcy.
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True
False
You, or your business, are presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee.
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True
False
You are obligated to pay alimony or child support.
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True
False
You are a guarantor, co-maker, or endorser for any debt of an individual, corporation, or partnerships.
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True
False
You have any outstanding letters of credit or surety bonds.
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True
False
You have legal actions or law suits pending against you.
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True
False
You are contingently liable on any lease or contract.
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True
False
You have past due tax obligations.
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True
False
You or your company have used a private lender in the past.
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True
False
Your tax returns of any Party are being audited or contested.
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True
False
Your personal and business’ tax obligations are current.
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True
False
Your stated income is likely to be reduced or interrupted within the next year.
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True
False
No Party is related through a family, financial, voting or control interest in any of the other parties to the transaction for which you are applying for a loan; including, without limitation, sellers, lenders, Realtors, or settlement agents.
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True
False
There will be other senior or subordinate liens or encumbrances on all or any portion of the subject property; including, seller carry-backs, second liens or other financing
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True
False
The subject property is being purchased as part of a “flip” or “wholesale” transaction
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True
False
There are other partnerships, affiliate relationships, joint ventures, agreements, understandings, deals, side agreements, or other similar arrangements that will have an ownership or financial interest in all or any portion of the subject property.
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True
False
You waive the right to receive a copy of the appraisal prior to signing loan documents.
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True
False
Please provide a brief explanation of any judgements, liens, foreclosures, or bankruptcies.
Do you have any other comments to add?