| Applicant Information (Complete if you are the sponsor) |
| *First Name: |
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| *Last Name: |
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| Company: |
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| Street address: |
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| City: |
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| Zip Code: |
(5 digits) |
| State: |
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| *Phone Number:: |
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| *Email:: |
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| Broker Information |
| *Broker name: |
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| *Phone number: |
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| *Email: |
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| Capital Request Information |
| *Capital request amount: |
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| *Capital request type: |
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| *Loan Duration Required:: |
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| *Purpose of Loan:: |
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| *Required closing date: |
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| *Reason for Close Date:: |
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| If other please indicate:: |
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| *Applicant(s) net worth: |
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| *Applicant(s) liquid net worth: |
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| *Applicants current and/or proposed investment in property:: |
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| Lien Information |
Amount of existing debt -
"first lien": |
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| Amount of existing debt - "other liens":: |
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| Property Information |
| *Property Type: |
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| If "other" please indicate: |
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| *Property Acreage, # of units, square footage, etc: |
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| *City and state: |
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| *Collateral Security Position: |
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| If "other", please indicate: |
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| *"as is" value: |
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| *Date of "as is" appraisal: |
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| Other Information |
| *Use of Proceeds - Please provide a concise description of the use of proceeds (i.e. site improvement, refinance, acquisition, etc): |
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| *Exit strategy - Please provide a concise description of the anticipated exit strategy (i.e. property sale, refinance with conventional debt, etc):: |
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| * Indicates a required field |
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