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Quick Data Form

Full Name

Current Residence Address

City

State

Zip Code

Home Phone

Cell Phone

Email

Estimated FICO Score

Current Employment/Occupation

Project Type: (SFR, Fix & Flip, GUC, Multi-Fam, Mixed-Use etc.)

Investment Property Address

City

State

Zip Code

Purchase Date

Purchase/Aquisition Price

Rehab/Value Add Costs

Remaining Mortgage Balance

Anticipated/Estimated Closing Date

Total Amount Requested

Taxes

Insurance

HOA Fees

Current AIV

Estimated ARV

Investor Project Capital Available

Requested Leverage%

Experience Level: (# Of Projects Completed Last 24 Months)

Business Entity LLC Name

Title Company Contact: (Name, Tel.#)

Insurance Company Contact: (Name, Tel.#)

Property Management Contact: (Name, Tel.#)

Loan Term & Exit Strategy

Why Are You Coming To Us, And Not Using Your Current Lender?

Additional Requests, Details, Comments

Investor/Borrower Declarations

I attest to the best of my knowledge, there are No Open Judgements, Undischarged Bankruptcy Cases, Delinquent State (or) Federal Tax Obligations/Leins, Unsatisfied Court Orders, Outstanding Alimony, Unpaid Child Support, Felony Convictions, Active Arrest Warrants, or pending Litigation Proceedings that have not been satisfied.

Name(s)

Signature(s)

Signature