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Broker Loan Referral Application


 Please provide us with the information requested below. We'll contact you promptly regarding the status of your application.

All information will be kept strictly confidential.
(Required information is noted with an asterisk*)

Broker Information
Your Name:*
Your Company:
Address:
City, State, Zip:
, ,
Home Phone:
Work Phone:*
ext:
E-mail Address:*
Please contact me by:
email, home phone, work phone
Best time to reach me:
Property/Structure Information
Approx. Property Value:* $
Property Purchase Price: $
Property Purchase Date:*
Any foreclosures, bankruptcies, leins, or judgements?*
Property Type:*
Does Borrower live on property?:*

Property Description:

Property Address:*
Property City & State:*
,
Net Rentable Area
(in square feet):
Number of Units:
Number of Vacancies
(if known):
Annual Property Income:
$
Does the Borrower Own Any Other Real Estate?*
Existing First Trust Deed
Present Balance:*
$ (if none type "0")
Original Balance:
$
Monthly Payment:
$ ,
current or past due:
Interest Rate:
, Term:
Existing Second Trust Deed
Present Balance:
$
Original Balance:
$
Monthly Payment:
$ ,
current or past due:
Interest Rate:
, Term:
Loan Quote Request
Requested Loan Type:*
Borrower's Credit:
Amount of Loan Requested:* $
Purpose of Loan:
Referral Fee Requested: $
Amount of Cash Down Payment (if purchase): $
Amount of Seller Carryback (if applicable): $

Term Desired:*

Comments/other issues: