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Loan Request Form
Borrower Information
Name
*
First Name
Last Name
Phone
*
Email
*
Company or Borrower Entity Name
*
FICO Score
Cash in Bank
*
Est. Annual Income
*
# of Rehabs/Flips (past 18-mos)
*
# of Rehabs/Flips (total)
*
Subject Property Information
Address
*
Address
City
California
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Purchase Price (or Current As-Is FMV)
ARV (if Rehab or Construction Loan)
Construction/Rehab Cost (Est.)
Loan Request Information
Loan Amount Requested
Transaction Type
*
Purchase
Purchase + Construction
Consumer Bridge
Refinance
Term
6-mos
12-mos
18-mos
2-5 years
Fund by Date
MM slash DD slash YYYY
Comments/Additional Information
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