Full Application
Loan Officer/Mortgage Broker
Are you a Mortgage Broker OR working WITH ONE?
Yes
No
Email Address
First Name
Last Name
Company Name
Phone Number
Are you a Loan Officer or working with one?
Yes
No
Email Address
First Name
Last Name
Company Name
Phone Number
What kind of program are you looking for?
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Bridge Loan
New Construction
Fix and Flip
DSCR Rental Loan
Transactional Funding
SBA Loan product
SBA 7a
SBA 504
Micro Loan
SBA Express
CAP Line
Community Advantage
SBA Veterans Advantage
International Trade
Export Working Capital
Export Express
Payroll Protection Program
EIDL
Additional Desired Loan programs
Bridge Loan
New Construction
Fix and Flip
DSCR Rental Loan
Transactional Funding
Where are you in the process?
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Looking for General Info
Actively Looking For Property
Identified a Property
Have Property Under Contract
I Own The Property/Land
lead source
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facebook
Other
How did you hear about us?
Borrower Info
First Name
Middle Name
Last Name
Borrower Email
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Secondary Email
Home Phone
Cell Phone
Fax
Cell Carrier
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AllTel
ATT
Cingular
Cricket
H20
Metro PCS
Boost Mobile
Nextel
Sprint PCS
Straight Talk
T-Mobile
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US Cellular
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Verizon
Preferred Communication
Phone
E-mail
Text
Web Portal
Is there a Co-borrower?
Alt. Phone #
Work Phone #
Address
Unit #
City
State
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Alabama
Alaska
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California
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Connecticut
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District of Columbia
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Zip Code
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Country
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United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
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Anguilla
Antarctica
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Argentina
Armenia
Aruba
Australia
Austria
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Bahrain
Bangladesh
Barbados
Belarus
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Belize
Benin
Bermuda
Bhutan
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Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
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Bouvet Island
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British Indian Ocean Territory
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Burundi
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Canada
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Cayman Islands
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Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
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Hungary
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Indonesia
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Iraq
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Isle of Man
Israel
Italy
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Japan
Jersey
Jordan
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Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
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Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.s.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Length of time at the present property
Length Of Time At The Present Property Months
Rent or Own
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Own
Rent
Rent Per Month Current Address
Has the borrower resided at the present address for less than two years?
Yes
No
Previous Address
Previous Unit #
Previous City
Previous State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Previous Zip Code
Previous Country
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United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.s.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Length of time at the previous property
Length Of Time At The Previous Property Months
Rent or Own
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Own
Rent
Rent Per Month Previous Address
Mailing Address
Mailing Address same as Current Address?
Mailing Address
Mailing Address Unit#
Mailing City
Mailing State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip Code
Mailing Address Country
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United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.s.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
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Own
Rent
Alternate Names
Alternate Section
1
First Name
First Name
First Name
Personal Info
Date Of Birth
Place Of Birth
Social Security Number
Driver License State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Driver License Number
Marital Status?
Unmarried
Married
Separated
Date of Marriage
Date of Divorce (If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Did you ever serve, OR are currently serving IN the United States Armed Forces?
Yes
No
Servicing member Info
Currently serving on active duty
Currently retired,discharged, or separated from service
Only period of service was as a non-activated member of the Reserve or National Guard
Surviving Spouse
Projected Expiration Date of Service/Tour
Ages Of Dependents
Number Of Dependents
Credit Score
Equifax Score
Transunion Score
Experian Score
Credit Score Range
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720 +
680 - 719
620 - 679
600 - 619
580 - 599
580 or Below
Foreign National- No Score
Co-borrower Information
First Name
Last Name
Email Address
Please Wait...
Home Phone
Cell Phone
Fax
Mobile Service Provider
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AllTel
ATT
Cingular
Cricket
H20
Metro PCS
Boost Mobile
Nextel
Sprint PCS
Straight Talk
T-Mobile
Tracfone
US Cellular
Virgin Mobile
Verizon
Same as borrowers address?
Address
City
State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Rent or Own
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Own
Rent
Is the Co-Borrower Guaranteeing the loan?
Yes
No
NA
Length of time at address
Has the borrower resided at the present address for less than two years?
Yes
No
Previous Address
Previous City
Previous State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Previous Zip Code
Rent or Own
- Select -
Own
Rent
- Select -
Own
Rent
Mailing Address
Same as borrowers mailing address?
Mailing Address
Mailing City
Mailing State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip
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Own
Rent
Personal Info
Date Of Birth
Place Of Birth
Social Security Number
Driver License State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Driver License Number
Driver License Issuance Date
Driver License Expiration Date
Marital Status?
Unmarried
Married
Separated
Married to Borrower?
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Equifax Score
Mid Fico Score
Transunion Score
Experian Score
Credit Score Range
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720 +
680 - 719
620 - 679
600 - 619
580 - 599
580 or Below
Foreign National- No Score
Borrower Type/Entity Info
Borrower Type
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Individual
Entity
Trust
Retirement Entity
Trust Type
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Revocable
Irrevocable
Retirement Entity
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Self-Directed IRA
Self-Directed 401K
IRA LLC
General Business Info
Entity Name
Trade Name/DBA
Entity Type
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Sole Proprietorship
Limited Partnership
General Partnership
LLC
Corp
S-Corp
Self Employed-1099 Contractor
501 (c)(3) Nonprofit
501 (c)(19) Veterans Org
Tribal Business
Trust
Joint Venture
Estate
Other
Date Of Formation
Time in Business
Less than 3 Months
3-6 Months
6-12 Months
1-2 Years
2-3 Years
3-5 years
5+ years
State Of Formation
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
States Registered In
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Federal Tax ID/EIN
Business License Number
Issuance Date
Expiration Date
State Issued
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other States Operating In
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
DBA Name(s)
Prior Business Name(s)
Organizational Ref #
Business Phone
Website Address
Business Address
Start Date at Location
Address
Address 2/Suite/Unit #
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Is the billing address the same as above?
Billing Address
Billing City
Billing State
-Select-
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Billing Zip Code
Location
Urban
Rural
Suburban
Property Ownership
- Select -
Own
Rent
Value of Property?
$
Total Debt on Property?
$
Name of Lender(s)?
Landlord/Mortgage Contact Name
Landlord/Mortgage Phone
Rent/Mortgage Payment
Business Details
Business Type
- Select -
Mobile & E-Commerce
Retail
Home Improvement
Food & Beverage
Travel and Tourism
Transportation
Meetings and Events
Education
B2B
Healthcare
Government
Non-Profit
Entertainment
Lodging
Legal
Salon & Spas
Professional Services
Other
# of employees currently
# of employees after loan
Business Category
- Select -
Agriculture,Forestry,Fishing
Construction
Manufacturing
Transportation & Public Utilities
Whole Sale Trade
Retail Trade
Finance Insurance Real Estate
Services
Public Administration
Utilities
Transportation and Warehousing
Professional, Scientific,Tech Services
Educational Services
Health Care and Social Assistance
Arts,Entertainment,Recreation
Restaurant,Internet,Mail Order/Telephone Order
Type of product or service sold
Naics Code
NAICS Code look up
Does your business sell a
Service
Product
Is your Business
B2B
B2C
Is your business home based?
Yes
No
Do you take credit card payments?
Yes
No
Terminal/ POS Make/Model
How many card processor banks do you have active?
Merchant Processing Bank Name(s)
Do you charge sales tax?
Yes
No
How are employees paid?
- Select -
W-2
1099
W-2 & 1099
Cash
Do you have more than one business location?
Yes
No
How many locations?
Other Location Details & Addresses
Is the business a franchise?
Yes
No
Name of Franchise
Point of Contact
Point of Contact Phone
Point of Contact E-mail
Website for Franchise
is your business seasonal?
Yes
No
if Yes, what are the peak months?
Business Description
Do you have Business Reference(s)?
Yes
No
1
)
Phone Name
Company
Fax
Email
Business Financials
Average Monthly Credit Card Sales
$
Average Monthly Deposits
$
Annual Revenue
$
Annual Gross Profit
$
YTD-Net Business Income
$
Date of Operating Agreement
Gross Annual Revenues $
$
Gross Income Last Year
$
Net Income Last Year
$
Gross Income 2 years ago
$
Net Income 2 years Ago
$
Average Bank Balance
$
Has business ever filed for bankruptcy?
Yes
No
Status of Business Bankruptcy
Still Active
Discharged- 1 month
Discharged- 1-3 months
Discharged- 3-6 months
Discharged- 6-12 months
Discharged-1 year
Discharged- 2 years
Discharged- 3 years
Discharged- 5 years
Discharged-7+ years
Recent NSFs
0
1
2
3
4
5
6
7
8
9
10+
Does your business owe taxes for years prior to the current year?
Yes
No
Estimated amount owed
$
Members/Officers
(List all members with 20% ownership or more.)
Same as Borrower/Applicant Info Above
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Cell
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Add More Members/Officers Info
Corporate Secretary Name
Notes
Sales Method
Retail Swiped
%
KEYED
%
ECOMM
%
MOTO
%
Fee Schedule
Visa/MasterCard/Discover/AXP Qualified Credit Card Discount Rate(for Tiered/Flat) %
%
Visa/MasterCard/Discover/AXP Qualified Credit Card Pass Thru I/C Plus
Qualified Check Card Discount Rate (for Tiered/Flat)
%
Qualified Check Card PassThru I/C Plus
Visa/MasterCard/Discover/AXP
$
Authorization Fee
$
Monthly Program Fee "Cash Discount"
$
Customer Service Fee
$
Monthly Minimum Fee
$
PIN Debit Transaction Fee
$
Batch Fee
$
Amex OPT Blue Qualified Rate
%
Amex OPT Blue Mid Qual
%
Amex OPT Blue Non Qual
%
Amex OPT Blue Pass Thru I/C Plus
Amex ESA #
AVS Transaction Fee
$
EBT Transaction Fee
$
EBT Account#
Amex Processing Fee
%
Other Fee
$
3 Tier Pricing Visa/MC/Disc/AXP Mid Qual
%
3 Tier Pricing Visa/MC/Disc/AXP Non Qual
%
Chargeback Fee
$
ACH Retrieval Fee
$
Equipment Info
Are you currently using a point of sale system?
Yes
No
Software
Software Version
Does your Business have a Land Line?
Yes
No
How will your new terminal connect to the internet?
--select--
WiFi
Ethernet
Telephone Land Line
Mobile Unit with Built in Cellular
Does your business location(s) have internet?
Yes
No
Do you have WiFi?
Yes
No
Do you know the password?
Yes
No
What is your Wifi password?
Do you expect your EBT?
Yes
No
What is your EBT number?
What would you like to have printed on the bottom of the receipt?
Is the equipment for a restraunt?
Yes
No
Do you want Tips Added On?
Yes
No
Do you want the customer to fill out Tip on Receipt or at cashier when they checkout only?
--select--
On Receipt
At Checkout Only
Suggested % #1
%
Suggested % #2
%
Suggested % #3
%
Do you want your Terminal to automatically Batch out? (Not recommended for restraunts. Once it batches out, unentered Tips will be lost).
Yes
No
At What Time?
Shipping Address
Shipping City
Shipping State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Shipping Zip Code
Additional Guarantors
Are there any additional guarantors?
Yes
No
First Name
Middle Name
Last Name
Phone #
Cell
SSN
Date Of Birth
Marital Status?
-Select -
Single
Married
An Entity
Divorced
Widowed
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Email
Credit Score
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Guarantor Notes
General Guarantor Notes
HMDA - (Borrower)
Do you wish to furnish this information?
Yes
No
N/A
What is your Ethnicity:
Hispanic or Latino
Mexican, Puerto Rican, Cuban, Other Hispanic or Latino
Mexican
Puerto Rican
Cuban
Other Hispanic or Latino
Print Origin
For example: Argentinean, Colombian, Dominican, Nicaraguan,Salvadoran, Spaniard, and so on
Not Hispanic or Latino
Not Disclosed
What is your Race:
American Indian or Alaska Native
Asian
Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Print Race
For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.
Black or African American
Native Hawaiian or Other Pacific Islander
Native Hawaiian, Guamanian or Chamorro, Samoan, Other Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
Print Race
For example: Fijian, Tongan, and so on.
White
Not Disclosed
Sex:
Male
Female
Not Disclosed
Veteran
an option for veteran
Non-Veteran
Veteran
Service-Disabled Veteran
Spouse of Veteran
Not Disclosed
HMDA - (Co-Borrower)
Do you wish to furnish this information?
Yes
No
N/A
What is your Ethnicity:
Hispanic or Latino
Mexican, Puerto Rican, Cuban, Other Hispanic or Latino
Mexican
Puerto Rican
Cuban
Other Hispanic or Latino
Print Origin
For example: Argentinean, Colombian, Dominican, Nicaraguan,Salvadoran, Spaniard, and so on
Not Hispanic or Latino
Not Disclosed
What is your Race:
American Indian or Alaska Native
Asian
Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian
Asian Indian
Chinese
Filipino
Japanese
Korean
Vietnamese
Other Asian
Print Race
For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.
Black or African American
Native Hawaiian or Other Pacific Islander
Native Hawaiian, Guamanian or Chamorro, Samoan, Other Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander
Print Race
For example: Fijian, Tongan, and so on.
White
Not Disclosed
Sex:
Male
Female
Not Disclosed
Veteran
Non-Veteran
Veteran
Service-Disabled Veteran
Spouse of Veteran
Not Disclosed
Borrower Background
Are you a U.S. Citizen?
Yes
No
Origin
Visa Status
Has the borrower been declared bankrupt within the past 7 years?
Yes
No
Status of Personal Bankruptcy
Still Active
Within 1 month
1-3 months
3-6 months
6-12 months
1 year
2 years
3 years
4 years
5 years
7+ years
If Yes, identify the types of bankruptcy
Chapter 7
Chapter 11
Chapter 12
Chapter 13
Please provide filing date, current status, properties included, etc...
Are there any outstanding judgments against the borrowers?
Yes
No
(If Yes, Provide explanation below.)
Do you have any active lawsuits against you?
Yes
No
(If Yes, Provide explanation below.)
Have you had or currently have any property tax liens?
Yes
No
(If Yes, Provide explanation below.)
Has the borrower directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?
Yes
No
Status of Foreclosure
Still Active
Within 1 month
1-3 months
3-6 months
6-12 months
1 year
2 years
3 years
4 years
5 years
7+ years
(If Yes, Provide explanation below.)
Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee
Yes
No
(If Yes, Provide explanation below.)
Have you ever been convicted of a felony or other fraud related crimes?
Yes
No
(If Yes, Provide explanation below.)
Are you in a Civil Union or a Domestic Partnership, or do you have a non-borrowing spouse, or are you a party to a Designated Beneficiary Agreement?
Yes
No
(If Yes, Provide explanation below.)
Within the past 7 years, have you completed a pre-foreclosure sale, whereby the property was sold to a third party and the Lender agreed to accept less than the outstanding mortgage balance due?
Yes
No
Have you had property foreclosed upon in the last 7 years?
Yes
No
Have you previously had a short sale?
Yes
No
When was the short sale?
Please explain the circumstances of the short sale
Background Explanation
Income tax returns filed through
Are any returns currently being audited or contested?
Yes
No
what years (s)
Have you drawn a will?
Yes
No
Please furnish the name of the executor(s) and year will was drawn
Have you ever had a financial plan prepared for you?
Yes
No
Is there a line of credit or unused credit facility at any other institution(s)?
Yes
No
Please indicate where, how much, and name of banker
Do you anticipate any substantial inheritances?
Yes
No
Please Explain
Co-borrower Background
Are you a U.S. Citizen?
Yes
No
Origin
Visa Status
Has the borrower been declared bankrupt within the past 7 years?
Yes
No
Please provide filing date, current status, properties included, etc...
Are there any outstanding judgments against the borrowers? (If Yes, Provide explanation below)
Yes
No
(If Yes, Provide explanation below.)
Do you have any active lawsuits against you?
Yes
No
(If Yes, Provide explanation below.)
Have you had or currently have any property tax liens?
Yes
No
(If Yes, Provide explanation below.)
Has the borrower directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?
Yes
No
(If Yes, Provide explanation below.)
Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee
Yes
No
(If Yes, Provide explanation below.)
Have you ever been convicted of a felony or other fraud related crimes?
Yes
No
(If Yes, Provide explanation below.)
Are you in a Civil Union or a Domestic Partnership, or do you have a non-borrowing spouse, or are you a party to a Designated Beneficiary Agreement?
Yes
No
(If Yes, Provide explanation below.)
Background Explanation
Borrower Experience
Does borrower have Fix & Flip or Buy & Hold experience?
Yes
No
# of years of experience?
# of properties completed in last 36 months
List 3 examples of past deals:
Property Type
- Select -
Single Family
Condo
Duplex
3 Units
4 Units
Multi-Family 5+
Mixed Use
Commercial
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Holding Title As
Ownership %
Ownership Status
- Select -
Owned
Sold
Exit
- Select -
In progess-To Be rented
In Progress- To Be Sold
Rented
Sold
Monthly Rent
Sale Price
Sale Date
Address
City
State
;
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Unit/Suite #
Outcome/Profit
Upload HUD
Property Type
- Select -
Single Family
Condo
Duplex
3 Units
4 Units
Multi-Family 5+
Mixed Use
Commercial
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Holding Title As
Ownership %
Ownership Status
- Select -
Owned
Sold
Exit
- Select -
In progess-To Be rented
In Progress- To Be Sold
Rented
Sold
Monthly Rent
Sale Price
Sale Date
Address
City
State
;
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Unit/Suite #
Outcome/Profit
Upload HUD
Property Type
- Select -
Single Family
Condo
Duplex
3 Units
4 Units
Multi-Family 5+
Mixed Use
Commercial
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Holding Title As
Ownership %
Ownership Status
- Select -
Owned
Sold
Exit
- Select -
In progess-To Be rented
In Progress- To Be Sold
Rented
Sold
Monthly Rent
Sale Price
Sale Date
Address
City
State
;
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Unit/Suite #
Outcome/Profit
Upload HUD
Does borrower have ground up construction experience?
Yes
No
# of years experience?
# of properties completed in last 36 months
List 3 examples of past deals:
Property Type
- Select -
Single Family
Condo
Duplex
3 Units
4 Units
Multi-Family 5+
Mixed Use
Commercial
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Holding Title As
Ownership %
Ownership Status
- Select -
Owned
Sold
Exit
- Select -
In progess-To Be rented
In Progress- To Be Sold
Rented
Sold
Monthly Rent
Sale Price
Sale Date
Address
City
State
;
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Unit/Suite #
Outcome/Profit
Upload HUD
Property Type
- Select -
Single Family
Condo
Duplex
3 Units
4 Units
Multi-Family 5+
Mixed Use
Commercial
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Holding Title As
Ownership %
Ownership Status
- Select -
Owned
Sold
Exit
- Select -
In progess-To Be rented
In Progress- To Be Sold
Rented
Sold
Monthly Rent
Sale Price
Sale Date
Address
City
State
;
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Unit/Suite #
Outcome/Profit
Upload HUD
Property Type
- Select -
Single Family
Condo
Duplex
3 Units
4 Units
Multi-Family 5+
Mixed Use
Commercial
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Holding Title As
Ownership %
Ownership Status
- Select -
Owned
Sold
Exit
- Select -
In progess-To Be rented
In Progress- To Be Sold
Rented
Sold
Monthly Rent
Sale Price
Sale Date
Address
City
State
;
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Unit/Suite #
Outcome/Profit
Upload HUD
Are you a builder/developer?
Yes
No
Do you have a GC on staff, or do you hire a third-party GC to complete rehab/construction?
Yes
No
Does borrower have experience selling properties without construction (e.g., wholesaling)?
Yes
No
# of years experience?
# of properties completed in last 36 months
Property Type
- Select -
Single Family
Condo
Duplex
3 Units
4 Units
Multi-Family 5+
Mixed Use
Commercial
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Holding Title As
Ownership %
Ownership Status
- Select -
Owned
Sold
Exit
- Select -
In progess-To Be rented
In Progress- To Be Sold
Rented
Sold
Monthly Rent
Sale Price
Sale Date
Address
City
State
;
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Unit/Suite #
Outcome/Profit
Upload HUD
Property Type
- Select -
Single Family
Condo
Duplex
3 Units
4 Units
Multi-Family 5+
Mixed Use
Commercial
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Holding Title As
Ownership %
Ownership Status
- Select -
Owned
Sold
Exit
- Select -
In progess-To Be rented
In Progress- To Be Sold
Rented
Sold
Monthly Rent
Sale Price
Sale Date
Address
City
State
;
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Unit/Suite #
Outcome/Profit
Upload HUD
Property Type
- Select -
Single Family
Condo
Duplex
3 Units
4 Units
Multi-Family 5+
Mixed Use
Commercial
Purchase date
Purchase Price
Amount Financed
Rehab Budget
Holding Title As
Ownership %
Ownership Status
- Select -
Owned
Sold
Exit
- Select -
In progess-To Be rented
In Progress- To Be Sold
Rented
Sold
Monthly Rent
Sale Price
Sale Date
Address
City
State
;
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Unit/Suite #
Outcome/Profit
Upload HUD
Does borrower have any projects currently in progress?
Yes
No
How many?
Does borrower own investment properties?
Yes
No
How many?
Is borrower a member of an investment club or group?
Yes
No
Name of Group/Club?
Do you have any professional licenses?
Yes
No
Select Professional license
- Select -
Real Estate
Mortgage
CPA
General Contractor
Attorney
Appraiser
Other
MD
DO
NP
RN
PA
Esthetician
License #
Are you a full time real estate investor?
Yes
No
How much liquid assets does borrower currently have?
Primary investment strategy
Residential fix & flip
Residential-buy & hold
Residential Wholesaling
Residential New Construction
Commercial- Fix & Flip
Commercial Buy & Hold
Commercial Wholesaling
Commercial-New Construction
Mixed Use
Multifamily
Other
Describe Your Overall Real Estate Investment Experience
Primary investment strategy Explain
Typical Transactions
Amount of financing requested
$
To
Amount of financing requested To
$
Typical purchase price
$
To
Typical purchase price To
$
Typical construction costs
$
To
Typical construction costs To
$
Typical sale price
$
To
Typical sale price To
$
No. of construction draws per project
To
No. of construction draws per project To
Months from purchase date to first construction draw
To
Months from purchase date to first construction draw To
Months from purchase date until construction complete
To
Months from purchase date until construction complete To
Months from purchase date to sale date
To
Months from purchase date to sale date To
No. of such projects that you will do at time
To
No. of such projects that you will do at time To
In which geographic areas do you intend to focus on the next 12-24 months?
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Co-borrower Experience
Does borrower have Fix & Flip or Buy & Hold experience?
Yes
No
NA
# of years of experience?
List 3 examples of past deals:
Outcome/Profit
Upload HUD
# of properties completed in last 36 months
Address
Outcome/Profit
Upload HUD
Address
Outcome/Profit
Upload HUD
Does borrower have ground up construction experience?
Yes
No
NA
# of years experience?
List 3 examples of past deals:
Outcome/Profit
Upload HUD
# of properties completed in last 36 months
Address
Outcome/Profit
Upload HUD
Address
Outcome/Profit
Upload HUD
Does borrower have experience selling properties without construction (e.g., wholesaling)?
Yes
No
NA
# of years of experience?
# of properties completed in last 36 months
List 3 examples of past deals:
Outcome/Profit
Upload HUD
Address
Outcome/Profit
Upload HUD
Address
Outcome/Profit
Upload HUD
Do you have any projects currently in progress?
Yes
No
NA
How many?
Does borrower own investment properties?
Yes
No
NA
How many?
Is borrower a member of an investment club or group?
Yes
No
NA
Name of Group/Club?
Do you have any professional licenses?
Yes
No
Select Professional license
- Select -
Real Estate
Mortgage
CPA
General Contractor
Attorney
Appraiser
Other
MD
DO
NP
RN
PA
Esthetician
License #
Are you a full time real estate investor?
Yes
No
How much in liquid reserves?
Primary investment strategy
Residential fix & flip
Residential-buy & hold
Residential Wholesaling
Residential New Construction
Commercial- Fix & Flip
Commercial Buy & Hold
Commercial Wholesaling
Commercial-New Construction
Mixed Use
Multifamily
Other
Primary investment strategy Explain
SBA Questions
$
$
Purpose of the loan:
Payroll
Rent/Mortgage Interest
Utilities
Other
Detailed Explanation
Is the Applicant (if an individual) or any individual owning 20% or more of the equity of the Applicant subject to an indictment, criminal information, arraignment, or other means by which formal criminal charges are brought in any jurisdiction, or presently incarcerated, or on probation or parole?
Yes
No
Detailed Explanation
Have you been arrested in the past six months for any criminal offense?
Yes
No
Detailed Explanation
Within the last 5 years, for any felony, has the Applicant (if an individual) or any owner of the Applicant 1) been convicted; 2) pleaded guilty; 3) pleaded nolo contendere; 4) been placed on pretrial diversion; or 5) been placed on any form of parole or probation (including probation before judgement)?
Yes
No
Detailed Explanation
Has an application for the loan you are applying for now ever been submitted to SBA or to a Certified Development Company or lender in connection with any SBA program?
Yes
No
Detailed Explanation
Is the Applicant a franchise that is listed in the SBAs Franchise Directory?
Yes
No
Detailed Explanation
Does the Small Business Applicant have any Affiliates?
Yes
No
Detailed Explanation
Has the Small Business Applicant and/or its Affiliates ever filed for bankruptcy protection?
Yes
No
Still Active
Within 1 month
1-3 months
3-6 months
6-12 months
1 year
2 years
3 years
4 years
5 years
7+ years
Detailed Explanation
Is the Small Business Applicant and/or its Affiliates presently involved in any pending legal action?
Yes
No
Detailed Explanation
Is the Applicant or any owner of the Applicant presently suspended, debarred, proposed for debarment, declared ineligible, voluntarily excluded from participation in this transaction by any Federal department or agency, or presently involved in any bankruptcy?
Yes
No
Detailed Explanation
If you are at least a 50% or more owner of the applicant business, are you more than 60 days delinquent on any obligation to pay child support arising under an administrative order, court order, repayment agreement between the holder and a custodial parent, or repayment agreement between the holder and a state agency providing child support enforcement services? .
Yes
No
Detailed Explanation
Has the Small Business Applicant and/or its Affiliates ever obtained a direct or guaranteed loan from SBA or any other Federal agency or been a guarantor on such a loan?
Yes
No
Is any of the financing currently delinquent?
Yes
No
Detailed Explanation
Did any of this financing ever default and cause a loss to the Government?
Yes
No
Detailed Explanation
Are any of the Small Business Applicants products and/or services exported or is there a plan to begin exporting as a result of this loan?
Yes
No
Provide the estimated total export sales this loan will support:
$
Is the Small Business Applicant using (or intending to use) a packager, broker, accountant, lawyer, etc. to assist in (a) preparing the loan application or any related materials and/or (b) referring the loan to the lender?
Yes
No
Detailed Explanation
Are any of the Small Business Applicants revenues derived from gambling, loan packaging, or from the sale of products or services, or the presentation of any depiction, displays or live performances, of a prurient sexual nature?
Yes
No
Detailed Explanation
No SBA employee, or the household member (see definition on page 1) of an SBA employee, is a sole proprietor, partner officer, director, or stockholder with a 10 percent or more interest, of the Applicant.
Yes
No
Detailed Explanation
No former SBA employee, who has been separated from SBA for less than one year prior to the request for financial assistance, is an employee, owner, partner, attorney, agent, owner of stock, officer, director, creditor or debtor of the Applicant.
Yes
No
Detailed Explanation
No member of Congress, or an appointed official or employee of the legislative or judicial branch of the Federal Government, is a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or household member of such individual, of the Applicant.
Yes
No
Detailed Explanation
No Government employee having a grade of at least GS-13 or higher is a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or a household member of such individual, of the Applicant
Yes
No
Detailed Explanation
No member or employee of a Small Business Advisory Council or a SCORE volunteer is a sole proprietor, general partner, officer, director, or stockholder with a 10 percent or more interest, or a household member of such individual, of the Applicant.
Yes
No
Detailed Explanation
Have you, or any business you controlled, ever filed for bankruptcy protection?
Yes
No
Detailed Explanation
Is the United States the principal place of residence for all employees of the Applicant included in the Applicants payroll calculation above?
Yes
No
Detailed Explanation
Do any of your employees earn more than $100,000/year?
Yes
No
If Yes, Did you calculate your estimated monthly payroll using the cap of 100,000 per employee?
Detailed Explanation
Has the Applicant, any owner of the Applicant, or any business owned or controlled by any of them, ever obtained a direct or guaranteed loan from SBA or any other Federal agency that is currently delinquent or has defaulted in the last 7 years and caused a loss to the government?
Yes
No
Detailed Explanation
Are you, or any business you control, presently involved in any legal action (including divorce)?
Yes
No
Detailed Explanation
Has the Business received an SBA Economic Injury Disaster Loan between January 31, 2020 and April 3, 2020?
Yes
No
Loan Amount
$
Detailed Explanation
Yes
No
Detailed Explanation
Other Business/Affiliate Information
Company Name
Tax Id/EIN #
Legal Owners/Title/Ownership %
# of employees
Years in Business
Has applied for SBA loans?
Yes
No
Description
Add Other Business Info
How many W-2 Employees do you have?
How many W-2s did you issue for 2020?
When was your company started?
-Select-
Before Jan 1, 2019
Between Jan 1, 2019 – Feb 15, 2020
After Feb 15, 2020
Did you operate under full or partial suspension due to government order?
No
Partial Suspension
Full Suspension
How your business was impacted during the partial or full shutdown
What quarters were you affected? (If not sure leave blank)
Q1 2020: (after the CARES Act took effect: March 13 - March 31, 2020)
Q2 2020: Apr – Jun
Q3 2020: Jul – Sep
Q4 2020: Oct – Dec
Q1 2021: Jan – Mar
Q2 2021: Apr – Jun
Q3 2021: Jul – Sep
Q4 2021: Oct – Dec
Please provide gross receipts of each quarter excluding any PPP funds if they are included as revenue
Q1 2019
$
Q2 2019
$
Q3 2019
$
Q4 2019
$
Q1 2020
$
Q2 2020
$
Q3 2020
$
Q4 2020
$
Q1 2021
$
Q2 2021
$
Q3 2021
$
Q4 2021
$
Did any of your vendors operate under full or partial suspension due to government order that affected your ability to do business?
No
Partial Suspension
Full Suspension
Not Sure
How your business was impacted during the partial or full shutdown
What quarters were you affected due to vendor delays
Q1 2020: (after the CARES Act took effect: March 13 - March 31, 2020)
Q2 2020: Apr – Jun
Q3 2020: Jul – Sep
Q4 2020: Oct – Dec
Q1 2021: Jan – Mar
Q2 2021: Apr – Jun
Q3 2021: Jul – Sep
Q4 2021: Oct – Dec
Please provide gross receipts of each quarter excluding any PPP funds if they are included as revenue
Q1 2019
$
Q2 2019
$
Q3 2019
$
Q4 2019
$
Q1 2020
$
Q2 2020
$
Q3 2020
$
Q4 2020
$
Q1 2021
$
Q2 2021
$
Q3 2021
$
Q4 2021
$
In 2020, which quarters experienced losses of at least 50% relative to the same quarter in 2019? If not, sure please leave blank
Q1 2020: (after the CARES Act took effect: March 13 - March 31, 2020)
Q2 2020: Apr – Jun
Q3 2020: Jul – Sep
Q4 2020: Oct – Dec
In 2021, which quarters experienced losses of at least 20% relative to the same quarter in 2019? If not sure, please leave blank
Q1 2021: Jan – Mar
Q2 2021: Apr – Jun
Q3 2021: Jul – Sep
Q4 2021: Oct – Dec
If you did receive a PPP loan(s), what was the amount(s)?
Draw 1
$
Draw 2
$
If you received a PPP loan(s), did you receive PPP loan forgiveness?
Draw 1
Yes
No
Draw 2
Yes
No
If you did have PPP loan forgiveness, what was the forgiven amount(s)?
Draw 1
$
Draw 2
$
Who is your payroll service provider?
Have you already claimed any Employee Retention Credits?
Yes
No
If Yes, which quarter(s) and with which company?
Are any employees that are family members or 50%+ owners? If so, please provide names
Have you started any other businesses since Feb 15th 2020 with annualized revenues of less than $1,000,000 and that has active W-2 employees?
Do you have any other existing businesses with active w-2 employees? If yes, please let business entity names and number of W-2 employees
Assets (Include Borrower + Co-borrower amounts if any)
Type
Estimated Value ($)
Amount Owed ($)
Cash
$
$
Checking Account(s)
$
Savings/Money Market/ CDs
$
Net worth of business(es) owned
$
Accounts & Notes Receivable
$
Accounts & Notes Receivable Owed
$
Stocks/Bonds
$
Stocks / Bonds Owed
$
Non-Marketable Securities
$
Non-Marketable Securities Owed
$
IRA / Keogh Accounts
$
IRA / Keogh Accounts Owed
$
401k / ESOP Accounts
$
401k / ESOP Accounts Owed
$
Life Insurance -- Cash Surrender Value Only
$
Life Insurance Owed
$
Total cash in bank accounts
$
Total value of retirement accounts
$
Availability under lines of credit
$
Line of Credit Owed
$
Home
$
Home Owed
$
Secondary Residences
$
Secondary Residences Owed
$
Other Real Estate
$
Other Real Estate Owed
$
Cars
$
Cars Owed
$
$
$
Other Personal Property
$
Other Owed
$
Other Assets
$
Notes Payable to Banks & Others
$
Installment Account(s)
$
Revolving Debt
$
Unpaid/Payable Taxes
$
Secured Notes Payable to this Bank
$
Unsecured Notes Payable to this Bank
$
Accounts Payable (including credit cards)
$
Margin Accounts
$
Other Liabilities Owed
$
Other Assets Details
Other Liability Details
Unpaid Taxes Details
Total:
$
$
Total Est. Value
- Total Amt Owed
= Total Net Worth
$
- $
= $
Gifts or Grants
Gifts Or Grants : 1
Asset Type
Cash Gift
Gift
Gift of Equity
Grant
Deposited/Not Deposited
Yes
No
NA
Source
Community Nonprofit
Federal Agency
Relative
State Agency
Lender
Employer
Local Agency
Religious Nonprofit
Unmarried Partner
Other
Cash Or Market Value
$
Add Gifts Or Grants Info
Financial Accounts & Securities
Total Verified Assets
$
Financial Accounts & Securities : 1
Account Type
Bridge Loan Proceeds
Bonds
Cash Value Of Insurance
Certificate Of Deposit
Checking
CD
Individual Development
Mutual Fund
Non-Marketable Securities
Retirement
Savings
Stock Options
Trust Account
Earnest Money
Employer Assistance
Lot Equity
Proceeds From Real Estate Property To Be Sold On Or Before Closing
Proceeds From Sale Of Non-Real Estate Asset
Relocation Funds
Rent Credit
Secured Borrowed Funds
Sweat Equity
Trade Equity
Unsecured Borrowed Funds
Other
Name of Institution
No. of shares/Face Value if Bond
Name of security
Cost
Market Value Quote/Exchange
Date of Quote/Exchange
Type of Policy
Face Amount
Amount Borrowed
Beneficiaries
Account Titled As
Account Number
Balance/Value
$
Owners
Description
Statement Date
Pledged (Held AS Collateral)
Yes
No
Add Financial Accounts & Securities
Contingent Liabilities
Contingent Liabilities
1
Type Of Liability
Endorser or Co-maker
Legal Claims & Judgement
Provision for Federal Income Tax
Outstanding Letters of Credit or Surety Bonds
Liable on any Lease or Contract
Other
Name of Company/Creditor
Monthly Payment
$
Months left to Pay
Balance/Amount
$
Account No
Estimated Tax Liability if you were to sell your major assets?
$
Description
Add New Contingent Liabilities
Schedule of Real Estate Owned and Sold
Schedule of Real Estate Info :
Property Address
Property Unit#
Property City
Property State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Property Zip
Property Country
United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.s.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Status
Sold
Pending Sale
Rental
Retained
Ownership %
%
Type Of Property
---Residential---
Single Family Home
Condo
Condo Low Rise
Condo High Rise
Loft
TownHouse
SRO
Manufactured
Duplex
3 Units
4 Units
2-4 Units
Lot/Land
Residential Portfolio
AirBnB
---Commercial---
Affordable Housing
Apartment Complex
Assisted Living Facility
Auto Repair
Bed & Breakfast
Bio-Energy
Boathouse
Car Wash
Church
Co-Op
Commercial Lot/Land
Condotel
Construction
Daycare
Developed Land
Equipment
Fractured Co-op
Fractured Condo
Funeral Homes
Garage/Storage
Gas Stations
Hospital
Hotel
Industrial
Infrastructure
Laundromat
Light Industrial
Medical Cannabis
Mixed Use
Motel
Multi-Family-5+
Mobile Home Park
Medical Office
New Residential Development
Owner Occupied Business
Office Building
Public Safety
PUD
Recreational Properties
Renewable Energy
Resorts
Restaurant/Bar
Retail
Self-Storage
Solar
Special Purpose Properties
Strip Mall
Student Housing
Tavern
Underlying Co-op
Warehouse
Wastewater Treatment
Water Treatment
Other
Investment Type
Rental
Flip
Present Market Value
Balance of Mortgages & Liens
Gross Rental Income
Mortgage Payments
Insurance, Taxes, HOA (If Not Included in Payment)
Net Rental Income
Titled Under
Date Purchased
Purchase Price
Value of Improvements Made
Intended Occupancy
Primary
Second Home
Investment
Other
Sale Date
Sale Price
$
Are there any mortgages or liens?
Yes
No
Creditor Name
Account Number
Loan Status
Current
Delinquent
Pending Short Sale
In Foreclosure
Monthly Payment
Interest Rate
%
Unpaid Balance
Type
FHA
VA
Conventional
USDA
Other
Credit Limit
To be Paid off at or before closing
Maturity Date
Is their another mortgage or lien?
Yes
No
Creditor Name
Account Number
Loan Status
Current
Delinquent
Pending Short Sale
In Foreclosure
Monthly Payment
Interest Rate
%
Unpaid Balance
Type
FHA
VA
Conventional
USDA
Other
Credit Limit
To be Paid off at or before closing
Maturity Date
Borrower Employment Information
Position or Title
Employment Type
- Select -
Self-Employed
1099
Salary W-2
Retired
Unemployed
Other
Start Date
Nature of Employers Business
I have ownership share of less than 25%
I have ownership share of 25% or more
Monthly Income/Loss $
$
How often are you paid?
Weekly
Monthly
Every 2 weeks
Twice a month
Employer Information
Employer Name
Years at job
Employer Address
Employer City
Employer State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Employer Zip
Employer Country
United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Please explain if employment history is less than 2 years
Employer Phone
May we contact you at work?
Years employed in this line of work / profession
Additional Employment Information :
1
Is this job an additional or previous Job?
Additional
Previous
Name
Address of Employer
Employer City
Employer State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Employer Zip
Employer Country
United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.s.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Employment Type
- Select -
Self-Employed
1099
Salary W-2
Retired
Unemployed
Other
I have ownership share of less than 25%
I have ownership share of 25% or more
Monthly Income/Loss $
Employed From
Employed To
Yrs employed in this line of work / profession
Employed by a family member, property seller, real estate agent, or other party to the transaction?
Are you the business Owner or Self-Employed?
Monthly Income
Overtime
Commission/Bonus
Military Entitlements
Other
Income from other sources
Alimony
Child Support
Interest and Dividends
Notes Receivable
Royalty Payments
Unemployment
Automobile Allowance
Disability
Mortgage Credit Certificate
Public Assistance
Separate Maintenance
Benefits
Boarder Income
Foster Care
Mortgage Differential
Retirement
Social Security
VA Compensation
Capital Gains
House or Parsonage
Payments
Trust
Other
Total Monthly Income from Other Sources
Position / Title / Type of Business
Employer Phone
Co-borrower Employment Information
Position or Title
Employment Type
- Select -
Self-Employed
1099
Salary W-2
Retired
Unemployed
Other
Start Date
Nature of Employers Business
I have ownership share of less than 25%
I have ownership share of 25% or more
Monthly Income/Loss $
$
How often are you paid?
Weekly
Monthly
Every 2 weeks
Twice a month
Employer Information
Employer Name
Years at job
Employer Address
Employer City
Employer State
Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Employer Zip
Employer Phone
May we contact you at work?
Years employed in this line of work / profession
Additional Employment Information
Additional Employment Information :
1
Name
Address of Employer
Employment Type
- Select -
Self-Employed
1099
Salary W-2
Retired
Unemployed
Other
I have ownership share of less than 25%
I have ownership share of 25% or more
Monthly Income/Loss $
Employed From
Employed To
Are you the business Owner or Self-Employed?
Monthly Income
Position / Title / Type of Business
Employer Phone
Borrower Monthly Income
Base Employment Income
$
Commission/Bonus
$
Military Entitlements
$
Overtime
$
Net Rental
$
Dividends / Interest
$
Capital Gains / (Losses)
$
Partnership / Subchapter S Income
$
Other
$
Other Income Description
Total Income
$
(Borrower)
Co-borrower Monthly Income
Base Employment Income
$
Commission/Bonus
$
Overtime
$
Net Rental
$
Dividends / Interest
$
Capital Gains / (Losses)
$
Partnership / Subchapter S Income
$
Other
$
Other Income Description
$
(Co-Borrower)
$
(Borr + Cobor)
Borrower Monthly Expenses
Monthly Payment
Bal Owed
This loan
$
$
Real Estate Taxes
$
HOA Fees
$
Insurances
$
Existing mortgages and Taxes/Insurance
$
Installment Loans
$
Credit Cards
$
Student Loans
$
Alimony/Child Support
$
Federal Income and Other Taxes
$
State Income and Other Taxes
$
Rental Payments, Co-op or Condo Maitenance
$
Mortgage Payments - Residential
$
Mortgage Payments - Investment
$
Property Taxes - Residential
$
Property Taxes - Investment
$
Interest & Principal Payments on Loans
$
Insurance
$
Investments (including tax shelters)
$
Tuition
$
Other Living Expenses
$
Medical Expenses
$
Other
$
Total Household Expenses
$
(Borrower)
Co-borrower Monthly Expenses
Monthly Payment
Bal Owed
Existing mortgages and Taxes/Insurance
$
Installment Loans
$
Credit Cards
$
Student Loans
$
Alimony/Child Support
$
Other
$
Total Household Expenses
$
(Co-Borrower)
$
(Borr + Cobor)
Liabilities
Alimony Payments
$
Child Support Payments
$
Separate Maintenance Payments
$
Job Related Expense (Child Care, union Dues, Etc).
$
Other Payments
$
Owed To
Creditors / Liabilities (Non-Real Estate)
Creditors / Liabilities (Non-Real Estate) : 1
Creditor/Company Name
Account #
Open
Closed
Current
Delinquent
Bankruptcy
Current
Delinquent
Foreclosure
In Dispute
Lawsuit
Other-See Description
Paid
Satisfied judgement
Short Sale
Unpaid collection
Type
Alimony
Auto Loan
Business Debts
Child Care
Credit card
IRS Tax
Judgements
Lease
Loan on Life Insurance
Medical
Other
Secured loans
Separation Maintenance
Student Loan
Unpaid Property Taxes
Unsecured loan
Authorized user
CoSigner
Individual
Joint Account
Maker (signer)
Shared Account
Undesignated
%
Min Payment $
$
Account Balance $
$
Pay at/before Closing?
Yes
No
Creditor Representative Details
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Collection Agency Details
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Sum Totals
$
$
Add More Creditors/Liabilities
Partnerships
Partnerships
1
Type of Investment
Business/Professional
Investments (Including Tax Shelters)
Date of Initial Investment
Cost
$
Percent Owned
%
Current Market Value
$
Balance Due on Partnership: Holds, Cash, Call
$
Final Contribution Date
Add New Partnerships
Other New Mortgage Loans on the Property
Other New Mortgage Loans : 1
Creditor Name
Lien Type
First Lien
Second Lien
Monthly Payment
$
Loan Amount/ Amount to be Drawn
$
Credit Limit
$
Add Other New Mortgage Loans
Loan Terms
Desired Closing Date
Desired loan amount
$
Funding Date
Desired Interest Rate Range
%
%
Borrower Occupancy
- Select -
Owner Occupied
2nd Home
Investment
Lien Position
- Select -
1st lien
2nd lien
3rd lien
Transaction Type
- Select -
Cash-Out / Refinance
Commercial Cash Out Refinance
Commercial Purchase
Commercial Rate / Term Refinance
Delayed Purchase
Line of Credit
New Construction - Existing Land
Purchase
Rate & Term Refinance
Refinance
Transactional
Application Loan/Exit Plan
Fix & Flip
Fix & Hold
Wholesale/Re-sale
Refi
Loan/Exit Plan
Fix & Flip
Fix & Hold
Wholesale/Re-sale
Refi
Long Term Rental
Short Term Rental
AirBnb
Build and Sell
Other
Account Executive Loan/Exit Plan Notes
Use Of Funds
Type of Purchase
- Select -
Auction
Foreclosure
HUD
MLS Listing
Off Market
Probate
REO
Sheriff Sale
Short Sale
Wholesale
Doc Type
- Select -
12 Month Bank Statements
24 Month Bank Statements
Full Doc
Lite doc
No Doc
Stated doc
Maturity Date
Loan Term
- Select -
Revolving
1 Month
2 Months
3 Months
4 Months
5 Months
6 Months
7 Months
8 Months
9 Months
10 Months
11 Months
12 Months
13 Months
14 Months
15 Months
16 Months
17 Months
18 Months
19 Months
20 Months
21 Months
22 Months
23 Months
24 Months
36 Months
48 Months
60 Months
72 Months
84 Months
120 Months
180 Months
240 Months
300 Months
360 Months
480 Months
360 Months- 30 Year Fixed - Fully Amortizing
360 Months- 5/6 ARM- 10 Year Interest Only
360 Months- Interest Only
360 Months- 3/1 ARM
360 Months- 5/1 ARM
360 Months- 5/6 ARM
360 Months- 7/1 ARM
360 Months- 7/6 ARM
360 Months- 10/1 ARM
360 Months- 3/1 ARM- Interest Only
360 Months- 5/1 ARM- Interest Only
360 Months- 7/1 ARM- Interest Only
360 Months- 7/6 ARM 10 year Interest Only
360 Months- 10/1 ARM- Interest Only
480 Months- 10 Yr Interest Only
%
Rate Lock Period
15
30
45
60
90
120
180
Rate Lock Date
Lock Expiration Date
Rate Lock Extension
Select
Yes
No
Rate Lock Notes
Do you want to calculate buyer interest rate based on Monthly Payment?
Yes
No
Buyer interest rate based on Monthly Payment
- Select -
Interest Only
10 Years
15 Years
20 Years
25 Years
30 Years
40 Years
Amortization Type
Fixed Rate
Adjustable Rate
Principal Repayment
- Select -
Interest Only
Principal + Interest
Principal & Interest
Payment Frequency
- Select -
Daily (365/Yr)
Daily (360/Yr)
Weekly (52/Yr)
Bi-Weekly (26/Yr)
Twice a Month (24/Yr)
Monthly (12/Yr)
Bi-Monthly (6/Yr)
Quarterly (4/Yr)
Semi-Annually (2/Yr)
Annually (1/Yr)
Current Loan Balance
Total Loan Amount
Set Manual Payment
$ 0
Accrual Type
30/360
30/365
Actual/360
Actual/365
Monthly Escrows for Taxes & Insurance
Yes
No
Annual Property Tax
$
Annual Insurance Policy Premium
$
0
Is this loan being cross collateralized?
Yes
No
How many properties are collateralized? (including subj property)
Are the properties owned free and clear?
Yes
No
Are these properties owned under the same entity as subject property?
Yes
No
Resale Price
$
Resale Closing Date
Will the property need rehab or construction?
Yes
No
Acquisition / Purchase Price
$
Property Value (AS-Is)
$
%
ARV
$
Is this ground up construction?
Yes
No
Lot Status
- Select -
Purchasing Lot
Paying Off Lot Loan
Lot Owned Free & Clear
Lot Purchase Price
$
Current Lot Market Value
$
Cost Spent
$
Original Purchase Price
$
Original Purchase Date
Construction Type
Developed Land
Tear Down
Major Construction
Construction Hard Cost
$
Construction Soft Cost
$
Contingency Type
10%
5%
Other
Contingency %
%
Contingency Amount
$
Plans and Permits Status
Draft
Approved
Other
Does project require re-zoning?
No
Yes
What is your anticipated hold time (months)?
Months
What is your anticipated plans and permit timeline (months)?
Months
What is your anticipated construction timeline (months)?
Months
maxAmtToPutDownClass
Acquisition Down Payment
$
commercialTdFieldsClass
Down Payment %
transactionalTdFieldsClass
Initial Loan Amount
$
rehabConsClsClass
LTV%
LOCTotalLoanAmt_dispClass
Initial Loan Amount
$
doesPropertyNeedRehabDispDivCLass1
Rehab/Construction Cost
$
doesPropertyNeedRehabDispDivClass2
Rehab/Construction % Financed
doesPropertyNeedRehabDispDivClass3
Rehab/Construction Cost Financed
$
propertyNeedRehabinitialTddispClass
Initial Draw Amount
$
payOffMortgage1_dispClass
Pay-Off on Mortgage 1
$
Pay-Off on Mortgage 2
$
Pay Off Oustanding Taxes
$
Closing Costs Financed
$
Total Draws Funded
$
propertyNeedRehabinitialTddispClass
$
CORTotalLoanAmt_disp
Total Loan Amount
$
Total Cash Out
$
Total Loan Amount
$
Total Project Cost
$
$
Total Loan Amount
$
Land Value
$
Simple ARV
%
Full ARV
%
Acquisition LTV
%
Market LTV
%
LTC - Total Loan Amount
%
% Of Rehab/Construction
(Cost Financed)
%
$
%
`
%
%
%
%
Current Mortgage Refinance Info
Current Mortgage Refinance Info
1
Lien Number
1st
2nd
3rd
Pay-Off Amount
$
Original Purchase Date
Current Lender
Current Lender Full Address
Current Lender Email
Original Purchase Price
$
Maturity Date of Loan
Pre-Payment Penalty $
$
Pre-Payment Penalty %
%
Cost of Improvements made
$
Are taxes and insurance included in the payment?
Yes
No
Monthly Payment
$
Current Rate
%
Current Loan Balance
$
Original Loan Balance
$
Add New Mortgage
Subject Property Details
1) Subject Property Details
Is this the main subject property?
Property Location
Subject Address
Subject Unit#
Subject City
Subject State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
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Illinois
Indiana
Iowa
Kansas
Kentucky
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Massachusetts
Michigan
Minnesota
Mississippi
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Oregon
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Puerto Rico
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South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
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Subject Zip Code
Subject Country
- Select -
United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.s.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
County
- Select -
Location
Urban
Rural
Suburban
Municipality
Parcel No
Legal Description
District
Section
Block
Lot
MSA
Property Characteristics
Subject Property Type
---Residential---
Single Family Home
Condo
Condo Low Rise
Condo High Rise
Loft
TownHouse
SRO
Manufactured
Duplex
3 Units
4 Units
2-4 Units
Lot/Land
Residential Portfolio
AirBnB
---Commercial---
Affordable Housing
Apartment Complex
Assisted Living Facility
Auto Repair
Bed & Breakfast
Bio-Energy
Boathouse
Car Wash
Church
Co-Op
Commercial Lot/Land
Condotel
Construction
Daycare
Developed Land
Equipment
Fractured Co-op
Fractured Condo
Funeral Homes
Garage/Storage
Gas Stations
Hospital
Hotel
Industrial
Infrastructure
Laundromat
Light Industrial
Medical Cannabis
Mixed Use
Motel
Multi-Family-5+
Mobile Home Park
Medical Office
New Residential Development
Owner Occupied Business
Office Building
Public Safety
PUD
Recreational Properties
Renewable Energy
Resorts
Restaurant/Bar
Retail
Self-Storage
Solar
Special Purpose Properties
Strip Mall
Student Housing
Tavern
Underlying Co-op
Warehouse
Wastewater Treatment
Water Treatment
Other
Condo Eligibility
Warrantable
Non Warrantable
Total Sq. Ft
Lot Size
Year Built
Features
Adj. Sq Ft
Waterfront
Construction Type
- Select -
Brick
Wood Frame
Timber Frame
Wood Panel
Steel Stud
Concrete Block/ICF
Modular/Pre-Fab
Manufactured
Construction Method
-Select-
Site-Built
Manufactured
Modular
Year Purchased:
Value Added View
Yes
No
Type of View
Mountain
Ocean
River
Lake
City
Golf
Other
Type Of Frontage
None
Ocean
River
Lake
Golf
Intercoastal
Other
Other
No of rooms
Bedrooms
Bathrooms
# Half Baths
Basement
Basement finished?
Garage
Rentable Sq. Ft.
# of Parking
# of buildings
Property Pool Indicator
Yes
No
Future Property Type
Single Family Home
2-4 Units
Detached Townhouse
Future Bedrooms
Future Bathrooms
Future # Half Baths
Is This Mid-Construction
Yes
No
What percentage of construction is complete?
%
Stabilized Rate
# of units
Future # of Units
Property Value
$
# of parcels
Owner Occupancy %
Current Commercial Tenant Occupancy Rate %
Anchor Tenant Y/N?
Yes
No
Anchor Tenant Name
What % is CRE
What % is resi
Property Class
Class A
Class B
Class C
# of Stories
Lease Type
Gross
Net
Mixed
Triple Net
Double Net
Modified Gross
Lease Validation
Appraisal Rents
Actual Leases
Market Rents
Other
Other
How Is The Property Currently Leased?
--select---
Long-Term Rental
Short-Term Rental
Month-to-Month
TBD
Is This a Planned Unit Development
Yes
No
PUD Name
Market Rents
$
Property Analysis
Allocated Loan Amount
$
Annual Hazard Insurance
$
Annual Flood Insurance
$
Total Hazard + Flood Insurance
$
Annual Property Tax
$
Property Tax Source
Property Tax Estimator
Tax Cert/Roll
Title Report
County Tax Assessor
Annual HOA Fees
$
Annual Total Expenses
$
Purchase Price
$
Total Existing Lien Payoffs
$
Gross Operating Income
$
Net Operating Income
$
30-Year Amortization Payment
$
Interest-only Payment
$
PITIA
$
ITIA
$
Value Used For Metrics(Purchase or AIV)
Purchase Price
AIV
Allocated LTP (Loan-To-Purchase)
%
Allocated LTV
%
Qualifying Allocated LTV
%
30-Yr AM DSCR
%
Property Details
Estimated Property Value
$
After Repair Value
$
Is Subject Property Listed for Sale?
Yes
No
Property List Price
$
Property List Date
Is construction or rehab complete?
Yes
No
Cost Spent?
$
Pay Off Lien Release
$
Purchase Price
$
Property LTV
%
Loan to purchase Price
%
Loan-To-After-Repair Value (LTARV)
%
Acquisition Date
Zillow value
$
Get Zillow Value
Price Per Door
$
URL link 1 to Property
URL link 2 to Property
Subject Present Occupancy
- Select -
Vacant
Rented
Tenant Occupied
Deliquent Renter
Deliquent Owner
Owner Occupied
FHA Secondary Residence
Seller Occupied
Occupancy Notes
Subject Property Condition
- Select -
Excellent
Good
Fair
Poor
Uninhabitable
Condition Notes
Year Renovated?
- Select -
Owner Occupied
Owner Occupied/Vacant
2nd Home
Non-Owner with Tenant
Non-Owner/Vacant
Tax year
Annual Property Taxes
$
Property Tax Due Date
Past Due Property Taxes: $
$
Lien Release/Payoff Amt
$
MLS Number
Annual Insurance Premiums
$
How long will it take for rehab to complete?
In Month
Property Access
Who to contact for property access? Name
Email
Lock Box Info
Phone:
Can we obtain interior access?
Yes
No
Relationship
Property Manager
Tenant
Real Estate Agent
Seller
Borrower
Other
Relationship
Rent Roll
Rent Roll
1
Tenant Name
Unit Type
Residential
Commercial
Unit #
Sq Ft
Bedroom
Bath
Half Baths
Lease Start Date
Lease End Date
Date of Last Rent Increase
Lease Payment Frequency
Annual
Month-To-Month
Short-Term Rental
Other
Lease Extension End Date
Move in Date
Preliminary Estimated Rents
$
Preliminary Rent Source
Actual Rents
Borrower Estimated Rents
Market Rents
Market Rents
$
120% Market Rents
$
Market Rent Source
RentRange
HouseCanary
RentCast
1007
Actual Rents
$
Lease Validation
Actual Rents
Market Rents
120% Market Rents
Monthly Rent
$
Subsidized
Yes
No
Vacant
Yes
No
Section 8
Yes
No
Comments
File Upload
Add New Rent Roll Entry
Property Flood Certificates
Property Flood Certificates
1
Is Building in a Special Hazard Zone
Yes
No
Flood Zone
X
D
C
B
A
AE
A1-30
AH
AO
AR
A99
V
VE
V1-30
Flood Certificate Company
Date of Determination
NFIP Map Number or Community Panel Number
NFIP Map Panel Effective/Revised Date
Flood Certificate Number
Notes
NFIP Non-Participating
Add New Property Flood Certificates Entry
Appraisers information
Appraiser
1
Appraiser First Name
Appraiser Last Name
Email
*
Appraiser Company
Phone
As Is Value
$
Rehabbed Value
$
Monthly Rent
$
Job Types
As Is
As Complete
As Complete / Stabilized
Insurable Value
Other
Date Obtained
Requested Return Date
Rush Order
Yes
No
N/A
Order Date
Comments
Upload Appraisal
Appraisal Effective Date
Primary Appraisal ECOA Delivery Date
Appraisal Inspection Date
Expected Delivery Date
Expected Delivery Delay #
Supplemental Product Form Type 1
Select
1007 Rent Schedule
1004D Completion
1004D Update
Exterior Only Disaster - PCR
Interior & Exterior Disaster - PCR
Effective Date 1
Supplemental Product ECOA Delivery Date 1
Supplemental Product Form Type 2
Select
1007 Rent Schedule
1004D Completion
1004D Update
Exterior Only Disaster - PCR
Interior & Exterior Disaster - PCR
Effective Date 2
Supplemental Product ECOA Delivery Date 2
Supplemental Product Form Type 3
Select
1007 Rent Schedule
1004D Completion
1004D Update
Exterior Only Disaster - PCR
Interior & Exterior Disaster - PCR
Effective Date 3
Supplemental Product ECOA Delivery Date 3
Add New Appraiser Entry
HOA information
is there a HOA?
Yes
No
Are HOA fees paid current?
Yes
No
Monthly HOA Fees
$
Delinquency Total?
$
Contact Name
Email
HOA Company Name
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZipCode
Contact Phone #
Fax #
Does HOA Allow Rentals
Yes
No
Is AirBnb Allowed
Yes
No
HOA applies to all properties
Yes
No
Is Community 55+?
Yes
No
Notes
Is there a Master/Secondary HOA/COA?
Yes
No
Amount
$
Contact Name
Email
HOA Company Name
Address
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Notes
Subject Property Cash Flow (Annualized)
Income Info
Residential Gross Potential Income
$
Residential Gross Potential Income Residential Calculate from Rent Roll?
Vacancy
$
Residential Vacancy Rate
%
Commercial Gross Potential Income
$
Commercial Gross Potential Income Commercial Calculate from Rent Roll?
Commercial Vacancy
$
Commercial Vacancy Rate
%
Other Income (Laundry,Parking,Other)
$
Other Income Vacancy
$
Other Income Vacancy Rate
%
Tenant Contributions
$
Tenant Contributions Vacancy
$
Tenant Contributions Vacancy Rate
%
Effective Gross Income
$
Expense Info
Annual Property Tax
$
Annual Insurance Policy Premium
$
HOA Fees
$
Operating Expenses
$
Water / Sewer
$
Electricity
$
Gas
$
Repairs/Maintenance
$
Legal
$
Payroll
$
Misc.
$
Common Area Utilities
$
Elevator Maintenance
$
Replacement Reserves
$
$
Tenant Reimbursements
$
Management Expense
$
%
Net Operating Income
$
Cap Rate
%
Reserves
$
0.00
Reserve Factor
$
Rentable Sq. Feet
Per Unit
Debt Service Ratio
0.00
Cash Available To Service Debt
$
0.00
Debt Service Ratio - PITIA
0.00
Gross Annual Rent of Largest Tenant
$
Estimated Project Cost/Use Of Funds Breakdown
Land Acquisition
$
New Building Construction
$
Construction Contingency (5-10%)
$
Business Acquisition
$
Land and Business Acquisition
$
Building or Leasehold Improvements/Repairs/Renovations
$
Acquisition of Machinery/Equipment
$
Acquisition of Furniture/Fixtures
$
Inventory Purchase
$
Working Capital (including Accounts Payable)
$
Refinancing existing business debt
$
Franchise Fee
$
Closing Cost (around 5% of loan amount)
$
Other Cost
$
Other Cost 2
$
total estimated project cost
$
LESS OWNER'S EQUITY TO BE INJECTED
$
LESS SELLER CARRY-BACK (If Applicable)
$
total loan requested for project
$
Collateral
Select all collateral available to support the loan
Commercial Real Estate
Market Value
$
Total Debt/Liens
$
Valuation Date
Description
Furniture & Fixtures
Market Value
$
Total Debt/Liens
$
Description
Residential Real Estate
Market Value
$
Total Debt/Liens
$
Valuation Date
Description
Vehicles
Market Value
$
Total Debt/Liens
$
Valuation Date
Description
Inventory
Market Value
$
Total Debt/Liens
$
Valuation Date
Used Equipment/Machinery
Market Value
$
Total Debt/Liens
$
Description
Accounts Receivable
Market Value
$
Total Debt/Liens
$
Valuation Date
Vacant Land
Market Value
$
Total Debt/Liens
$
Valuation Date
Description
Cash
Market Value
$
Total Debt/Liens
$
Leasehold Improvements
Market Value
$
Total Debt/Liens
$
Description
Investment Accounts
Market Value
$
Total Debt/Liens
$
Description
Retirement Accounts
Market Value
$
Total Debt/Liens
$
Description
New Equipment/Machinery
Market Value
$
Total Debt/Liens
$
Description
Other
Market Value
$
Total Debt/Liens
$
Valuation Date
Description
None
Detailed description of collateral
VENDOR & EQUIPMENT INFORMATION
1
)
Vendor Phone
Vendor Contact
Equipment Type
- Select -
Vehicle
Farming Equipment
Construction Equipment
Restaurant Equipment
Office Equipment
Medical Equipment
Robotic Equipment
Industrial Equipment
Equipment Detailed Type
- Select -
Automotive Repair
Bowling Alley Equipment
Chippers
CNC Machine
CNC Saw
Compressor
Computer Hardware
Computer Software
Computer Software
Construction Equipment
Copiers
Cranes
Dairy Equipment
Fitness Equipment
Floor or Inventory Financing
Food Service
Forklifts
Funeral & Cremation Equipment
HVAC Units
Lab Testing Equipment
Landscaping Equipment
LED Lighting
Light Towers
Logging Equipment
Material Handling
Medical Laser
Playground Equipment
Pre-approval-TBD
Rental Equipment
Restaurant Equipment
Scaffolding
Signs & Awnings
Tanning Equipment
Therapy Equipment
Trailer - Dry Van
Trailer - Reefer
Trailer - Utility
Truck- Box Truck
Truck - Dump Truck
Truck-Pickup
Truck- Vocational
Truck, Class 8 - Day Cab
Truck, Class 8 - Sleeper
Vehicle - Ambulance
Vehicle - Hearse
Vehicle - Tow Truck
Vehicle - Vocation Work Truck
Vehicle - Work Van
Warehouse Equipment
Warehouse Racking
Waste Recyling Containers
Welders
Other
Vin or Serial Number
Year
Sale Price
New Or Used
New
Used
Make
Model
Quantity
Mileage
Equipment Description
Pictures of Property
Select file to upload
Add Pictures Property
1st Lien Current Mortgage Scenario
Loan Type
- Select -
2/28 ARM
3/27 ARM
5/25 ARM
7/1 ARM
10/1 ARM
10 Year Fix
15 Year Fix
20 Year Fix
30 Year Fix
40 Year Fix
40/30 Year Fix
Pay Option Arm
HELOC
Other
ARM
Fixed Rate
Step Rate
Balloon
- Select -
Interest Only
3 Years
5 Years
10 Years
15 Years
20 Years
25 Years
30 Years
40 Years
10/30 Years
15/30 Years
40/30 Years
50/30 Years
Remaining Months
Current Unpaid Principal Balance
$
Original Loan Amt
$
Loan Number
Notice of Acceleration
Loan Origination Date
Remaining Months
Months Behind (Manual Entry)
- Select -
0
Imminent Default
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
36+
Last Payment Made
Days Behind
Transfer of Servicing Date
Original Lender
Current Lender/Servicer
Mortgage Type
- Select -
FHA
FmHA
VA
Conventional with PMI
Conventional wo PMI
Rural
Mortgage Investor/Owner
- Select -
Fannie Mae
Freddie Mac
Held in Bank/Lender Portfolio
Private Investor Owned
FHLB
GNMA
Unknown
Monthly Payment Details
$
Monthly Taxes
$
Monthly Property Insurance
$
Flood Insurance
$
Priv. Monthly Mortg. Insurance
$
$
Total Monthly Payment
$
Past Due Interest
Out of Pocket Escrow Adv
$
Out of Pocket Escrow Adv
$
Past Due Mtg. Ins
$
Past Due H.O.A
$
Late Fees (Not Included)
$
Rep Name & all other contact info....
Rep Name
Phone #
Fax #
Cell #
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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Indiana
Iowa
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Louisiana
Maine
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Michigan
Minnesota
Mississippi
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New York
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Ohio
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Puerto Rico
Rhode Island
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South Dakota
Tennessee
Texas
Utah
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Zip
E-mail
Notes
2nd Lien Current Mortgage Scenario
2nd lien Loan Type
- Select -
Fixed 2nd
HELOC
Seller Held 2nd
Other
Adjustable
ARM
Fixed Rate
Balloon
Terms
- Select -
Interest Only
3 Years
5 Years
10 Years
15 Years
20 Years
25 Years
30 Years
40 Years
10/30 Years
15/30 Years
40/30 Years
50/30 Years
Remaining Months
Rate %
Current Unpaid Principal Balance
$
Original Loan Amt
$
Payment
$
Loan Number
Past Due Interest
Last Payment Made
Current Lender/Servicer
Months Behind (Manual Entry)
- Select -
0
Imminent Default
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
36+
Days Behind
Original Lender
Mortgage Type
- Select -
FHA
FmHA
VA
Conventional with PMI
Conventional wo PMI
Rural
Mortgage Investor/Owner
- Select -
Fannie Mae
Freddie Mac
Held in Bank/Lender Portfolio
Private Investor Owned
FHLB
GNMA
Unknown
Rep Name & all other contact info....
Rep Name
Phone #
Fax #
Cell #
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
E-mail
Notes
Foreclosure / Default Info
Has the borrower been 30+ days late in the past 12 months ?
Yes
No
NA
Is the mortgage currently behind?
Yes
No
NA
Has the borrower received a notice of foreclosure or default by the bank, attorney, or trustee?
Yes
No
NA
Type / Select the date Notice of Default received
Has client received notice of summons?
Yes
No
NA
Type / Select the date Notice of summons received
Type / Select Sales Date if provided by bank/attorney/trustee
Trustee Sale #
Jurisdiction
Index #
Attorney Information
First Name
Last Name
Firm Name
Email
Phone
Fax
Cell
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Trustee Information
First Name
Last Name
Firm Name
Email
Phone
Fax
Cell
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Notes
Loan Workout Q & A
Do you want to keep the property?
Yes
No
NA
Have you applied for a loan modification?
Yes
No
NA
Date of application
Date of modification
Please provide all details
Has the borrower filed for bankruptcy?
Yes
No
NA
Is the borrower behind on plan payments?
Yes
No
NA
Filing Date
What is the Bankruptcy disposition status?
- Select -
Discharged
Dismissed
Relief of Stay
Active
Bankruptcy Case number
Date discharged
Was the mortgage debt reaffirmed?
Yes
No
NA
Are the property(s) included in the bankruptcy?
Yes
No
NA
Is this home currently listed for sale?
Yes
No
NA
For how long?
For Sale by Owner?
Yes
No
NA
Listing Realtor Name
Real Estate Agency
Listing Phone
Listing Price
$
Listing Date
Has the borrower received an offer on the property?
Yes
No
NA
Date of offer
Amount of offer
$
Does the borrower have more than one property?
Yes
No
NA
How many properties?
How many mortgages?
Are the property taxes currently delinquent?
Yes
No
NA
Delinquent tax total?
$
Which year(s) are delinquent?
How many people live in the property?
How many are dependents live in the property?
How many vehicles are owned?
Is there a person not on the mortgage note who lives in the residence and contributes financially to the household?
Yes
No
NA
How many years has the borrower lived in the property?
Is the borrower a natural person (NOT an entity like corp, llc, trust, etc...) ?
Yes
No
NA
Is any borrower a service member?
Yes
No
NA
Has any borrower recently been deployed away from their principal residence or recently received a permanent change of station order?
Yes
No
NA
Is any borrower the surviving spouse of a deceased service member who was on active duty at the time of death?
Yes
No
NA
Answer YES, if you have been convicted within the last 10 years of any one of the following in connection with a mortgage or real estate transaction: (a) felony larceny, theft, fraud or forgery, (b) money laundering or (c) tax evasion.
Yes
No
NA
Additional Questions
Is there an accepted purchase agreement?
Yes
No
Purchase Agreement Expiration date
Loan Guarantee
-- Select One --
Recourse
Non-Recourse
Success Fee Payment
50%
100%
Is there a wholesale fee involved with this purchase?
Yes
No
How much is the wholesale fee?
$
Loan/Exit Plan
Fix & Flip
Fix & Hold
Wholesale/Re-sale
Refi
Long Term Rental
Short Term Rental
AirBnb
Build and Sell
Other
Loan/Exit Plan Explanation
What is the projected rental income per month?
$
Expected timeline to exit
Is the property subject to any additional liens, encumbrances, or restrictions (i.e. Property Assessed Clean Energy Program aka PACE)?
Yes
No
Please explain
Is the subject property(ies) currently under construction?
Yes
No
Are you adding square footage?
Yes
No
How many additional square feet are you adding?
Improvements to be Completed
Renovation Timeframe (months)
Will there be a 2nd lien or borrowed money for down payment?
Yes
No
Secondary Financing Amount
$
(If Yes, Provide explanation.)
Do you have invoices to factor?
Yes
No
Amount
$
Do you have a current loan/advance balance?
Yes
No
Balance
$
Held With
Does the borrower intend to occupy the property as their primary residence?
Yes
No
Have you had ownership interest in another property in the last 3 years?
Yes
No
What type of property did you own?
-- Select One --
Primary Residence
FHA Secondary Residence
Second Home
Investment Property
How did you hold title to the property
-- Select One --
Jointly with Spouse
Jointly with Another Person
Yourself
Are you borrowing any money for this real estate transaction or obtaining any money from a nother party, such as the seller or realtor, that you have not disclosed on this loan application?
Yes
No
If Yes, what is the amount of this money?
$
Purpose(s) of loan
-- Select One --
Working Capital
Start a Business
Accquire a Business
Purchase Inventory
Purchase Machinery or Equipment
Make Building Improvements
Building Acquisition
Refinance Existing Debt
Vacant Lot/Ground-Up Construction
Tear Down and Rebuild
Mid-Construction Refinance
Other
Please Explain
Desired Funding Amount
$
Assumability
Yes - See Terms & Conditions
No
Security Instrument
-- Select One --
Deed of Trust
Mortgage
Security Deed
Do you own the land?
Yes
No
-- Select One --
Fee Simple
Fee Simple Absolute
Fee Simple Defeasible
Leasehold
Life Estate
Tenancy in Severalty
Tenancy in Common
Joint Tenancy
Tenancy by Entirety
Will borrower personally guarantee this loan?
Yes
No
Is this Loan subject to a Balloon Payment?
Yes
No
Use Of Funds
Does the co-borrower intend to occupy the property as their primary residence?
Yes
No
Is there a prepayment penalty for paying in excess of 20% of the original or unpaid loan balance?
Yes
No
Is this loan based on limited or no Documentation of your Income and/or Assets?
Yes
No
Will this loan be made wholly or in part from broker controlled funds as defined in section 10241(J) of the Business and Professions code?
May
Will
Will Not
Do you have a family relationship or business affiliation with the seller of the property?
Yes
No
Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on this loan application?
Yes
No
Have you or will you be applying for any new credit (e.g. installment loan,credit card, etc) on or before closing this loan that is not disclosed on this application?
Yes
No
Are there any known hazards or safety issues (mold, foundation, structural, etc.)?
Yes
No
Are professional reports available outlining the issues and remediation?
Yes
No
Is this transaction subject to short sale approval by an existing lender?
Yes
No
Display Notes
Use of Proceeds
Any significant changes in the next 12 months?
Yes
No
Please Describe
Title Info
Current Name on Title
New Name on Title
- Select -
Fee Simple
Fee Simple Absolute
Fee Simple Defeasible
Leasehold
Life Estate
Tenancy in Severalty
Tenancy in Common
Joint Tenancy
Tenancy by Entirety
Recording #
Title Order Number
Title Ordered Date
Title Report Date
Title Received Date
Borrower Vesting Information
- Select -
Joint tenancy with right of survivorship
Community property with right of survivorship
Tenancy in Common
Sole Ownership
Living Trust
Title Report
Title Exceptions
Title Info : 1
Title Rep First Name
Title Rep Last Name
Title Company
E-mail
Phone #
Cell
Fax
Toll Free
Title Address
Title City
Title State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Title Zip
Title Notes
Add Title Info
Attorney Info
Attorney Info : 1
Attorney Name
Attorney Firm Name
Bar #
Attorney Phone
Attorney E-mail
Add Attorney Info
Escrow Info
Escrow Info : 1
Escrow Rep First Name
Escrow Rep Last Name
Company
E-mail
Phone #
Toll Free
Fax
Cell
Escrow #
Escrow Address
Escrow City
Escrow State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Escrow Zip
Add Escrow Info
General Contractor
First Name
Last Name
Email
Company Name
License Number
Phone
Website
Cell Number
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Toll Free
Financial Advisor
Financial Advisor : 1
First Name
Last Name
Name Of Company
Email
Phone
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Website
Financial Advisor Notes
Add Financial Advisor
Accountant Info
Accountant : 1
First Name
Last Name
Name Of Company
Email
Phone
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Website
Notes
Add Accountant
Insurance Agent Info
Insurance Agent Info
1
Insurance Rep First Name
Insurance Rep Last Name
Name of Company
E-mail
Phone
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Website
Insurance Rep Notes
Add New Insurance Agent Info
Billing/Payment Information
Check
Checking ACT Bank Name:
Checking ACT Holder\'s Name on Account
Same as Mailing Address?
ACT Holders Address of Record with Bank
ACT Holders City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
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
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
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Wyoming
Zip
9 Digit Bank Routing Number
Checking ACT Number
Deposit Date
Account Type
Personal Checking
Personal Savings
Business Checking
Credit Card
Type of Card
- Select Credit Card Type -
VISA
MASTER CARD
AMEX
DISCOVER
Card #
- Month -
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
- Year -
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Card Holders Name on Card
CVV #
Same as Mailing Address?
Card Holders Address
ACT Holders City:
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
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Nevada
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New Jersey
New Mexico
New York
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Ohio
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Texas
Utah
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Washington
West Virginia
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Zip
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Terms And Conditions
By submitting this application, you acknowledge that everything is true and correct to the best of your knowledge. If Pre-approved, you authorize us to pull
your credit report. Certain fees, like an appraisal fee may not be refundable in the event your loan does not close with us.
By checking this box I agree to the terms and conditions.
the Terms and Conditions
*
Borrower
By checking this box I agree to the Terms and Conditions above
By checking this box I agree to the Terms and Conditions above
Name Of Borrower
Date (System Generated)
Name of Borrower Signing:
Signature
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Co Borrower
By checking this box I agree to the Terms and Conditions above
By checking this box I agree to the Terms and Conditions above
Name Of Co Borrower
Date (System Generated)
Name of Co-Borrower Signing:
Signature
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