Loan Amount
Position
1st. Mortgage
2nd. Mortgage
Bridge Loan (fast,short term)
Construction
Property Type
Apartment Building
Agricultural or Ranch Property
Assisted Living Facility
Auto Dealership/Used Car Lot
Bed & Breakfast Inn
Casino
Churche
Assisted Care Facility
Gas Station
Golf Course
Hotel or Motel
Industrial Building
Land
Self Storage Warehouse
Mixed Use Property
Mobile Home Community
Office Building
Parking Garage
Residential Care Home
Residential Condo
Residential Subdivision
Restaurant
Retail Building
Skilled Nursing Facility
Shopping Center
Special Use Property
Other Commercial Property
Property Address
Property City State and Zip
Property Value
Your First Name
Your Last Name
Your Occupation
Your Company Name
Optional
Your Address
Suite #
City, State, and
Zipcode
,
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VI
VA
WA
WV
WI
WY
Home Telephone
Work Telephone
FAX
Optional
Mobile Phone number
Optional
E-mail address
Do you check your
E-mail daily?
yes no
Describe the property in
common terms. On a scale from 1 to 10 (1 lowest - 10 highest), how
appealing is it? What are the
flaws? How many vacancies? Do you
or your your business occupy any part of this
property? If so, what percentage?
What do you plan to do with
the proceeds? Are you paying
off any loans? Is speed to closing or lowest
rate most important?
Have you applied to anyone else
for this loan? If so, who? What
is the status of the application with the
other lender(s)? Were there any problems
noted by the other lender(s)?
What is your annual income?
less than $25,000
$25,000 to $50,000
$50,000 to $75,000
$75,000 to $100,000
$100,000 to $150,000
$150,000 to $250,000
$250,000 to $500,000
more than $500,000
What is your approx. net worth?
less than $250,000
$250,000 to $500,000
$500,000 to $1,000,000
$1,000,000 to $2,000,000
$2,000,000 to $5,000,000
$5,000,000 to $10,000,000
more than $10,000,000
How is your credit? What other potential
problems should the lender know about? Use this space to give me your special comments.