BORROWER INFORMATION

Borrower Name:

Entity Type: Individual Partnership LLC Corporation Other

Contact Name:

Email Address:

Borrower Address:

City:    State:      Zip:

Phone:  Fax:

Borrower Credit:

Ever declare Bankruptcy? Yes No

If yes; Year :   Year Discharged:

B) PROPERTY INFORMATION

Project Name:

Address:

City:   State:       Zip:

Type of Project:

Number of Beds/Units:                   Current Occupancy%

Title Form: Fee Simple Leasehold         Last Appraisal Date: 

Appraised Value: $

Borrowers Est. of Current Value: $

Property Physical Condition: Excellent Good Fair Poor

Year Built:     Year Renovated:

Elevator: Yes No     Number of Floors Gross Floor Area: 

Number of Buildings:      Accessory Buildings:

Dimensions:ft. by ft., or Acres

Zoning:

Structural System:

Exterior Finish:

Heating A/C System:

C) MORTGAGE LOAN REQUEST

Requested Loan Amount:

Permanent Construction 

FINANCING PURPOSE:

REFINANCE: Rate/Term Cash Out

Mortgage Balance:     Rate%

Maturity: -- mm/dd/yy    Use of Proceeds:

PURCHASE: Purchase Price:

Projected Closing Date: