APPLICATION

Please submit the following information:

Date *

Name of Borrowing Entity(required) *

Address of Borrowing Entity(required) *

City (required) *

State (required) *

ZIP Code (required) *

Phone Number (required) *

Email *

Name of Principals (Guarantors)(required) *

Subject Property (Collateral)(required) *

Address of Subject Property(required) *

City of Subject Property (required) *

State of Subject Property (required) *

ZIP Code of Subject Property (required) *

Loan Amount $(required) *

Max LTV%(required) *

Points to Lender % (required) *

Points to Borrowers Agent % (required) *

Term of Loan (required) *

Rate of Interest % (required) *

Name of Borrowers Agent (required) *

Address of Borrowers Agent (required) *

Phone # of Borrowers Agent (required) *

Email of Borrowers Agent *

I (borrowers agent)________have explained the contents of this request to the proposed borrowers. They have agreed to the terms and request that these terms be presented in writing.(required) *

Name