Submission Office:

Principal's Name:   Title:

Address:

City:   State:      Zip:   

Phone:   Fax:   Web:

E-mail:   Loan Amount: $

Purpose of Loan - (Describe why we should fund you - 400 character spaces):

Description of Collateral / Property (400 character spaces):

As-is Market Value: $    

As-is Quick Sale Value (90 - 120 day sale): $

As-Improved Market Value (Construction Loans Only): $

As-Improved Quick Sale Value (Construction Loans Only): $

Existing Debt: $  

Use of Proceeds (400 character spaces):

Plan for Repayment (400 character spaces):

How Did You Hear About Us?

Spoken to a Network Loan Officer?  Yes No  

Who?