Broker / Banker Information - Please provide the following contact information:

First name
Last name
Title
Company
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
FAX
E-mail
Website

Loan Summary - Please complete all fields or your request will not be reviewed

Type of Loan Purchase Refinance

Type of Property Single Family Home 2-4 Units 5-12 Units 12+ Units - Please indicate specifics below Commerical Raw Land Custom Lots Other - Please describe below

Loan Amount Requested:

Property Value / Sale price*: *please indicate lower of two.

Property Square Footage:

Lot Size:

Bedroom count:

Bathroom count:

City and State Property is Located:

Brief summary of the property and its condition:

Current Loan Amount on 1st Mtg.:

Current Interest Rate on 1st Mtg.:

Current Payment of 1st Mtg.:

Current Loan Amount on 2nd Mtg.*:

Current Interest Rate on 2nd Mtg.*:

Current Payment of 2nd Mtg.*:

Credit Perfect - No Lates Good - Less than 2 30 days Fair - Less than 5 30 days Poor - More than 5 30 days

Borrower FICO Score:

Total Minimum Payments of all credit:

Borrowers Monthly Income:

Brief Summary of Transaction:

What are the issues of this transaction that require it to have this type of financing:

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