Quick Application Form

Are you working with a Broker?

Yes No

First Name

Last Name

Broker Phone

What type of loan are you looking for?

Where are you in the process?

How did you hear about us?

First Name

Last Name

Borrower Email

Cell Phone

Address

City

State

Zip Code

Yes No

Unmarried Married Separated

U.S. Citizen Perm Resident Alien Non-Perm Resident Alien

Yes No

Currently serving on active duty Currently Retired, discharged, or separated from service Non-activated member of the Reserve or National Guard Surviving Spouse

Yes No

Mailing Address

Personal Info

Unmarried Married Separated

Yes No

U.S. Citizen Perm Resident Alien Non-Perm Resident Alien

Yes No N/A

Hispanic or Latino Not Hispanic or Latino Not Disclosed

Male Female Not Disclosed

Non-Veteran Veteran Service-Disabled Veteran Spouse of Veteran Not Disclosed

To Be Completed by Financial Institution (for application taken in person)

Yes No

The Demographic Information was provided through

Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet

Yes No N/A

Hispanic or Latino Not Hispanic or Latino Not Disclosed

Male Female Not Disclosed

Non-Veteran Veteran Service-Disabled Veteran Spouse of Veteran Not Disclosed

To Be Completed by Financial Institution (for application taken in person)

Yes No

The Demographic Information was provided through

Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet

Yes No

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address
City
State
Zip

Upload HUD

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address
City
State
Zip

Upload HUD

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address
City
State
Zip

Upload HUD

Yes No

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Yes No

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Yes No NA

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Yes No NA

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Yes No NA

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Yes No NA

Yes No

Payroll Rent/Mortgage Interest Utilities Other

Yes No

Loan Amount

Yes No

Other Business/Affiliate Information

Company Name

Tax Id/EIN #

Legal Owners/Title/Ownership %

# of employees

Years in Business

Has applied for SBA loans?

Yes No

Description

No Partial Suspension Full Suspension

Q1 2019

Q2 2019

Q3 2019

Q4 2019

Q1 2020

Q2 2020

Q3 2020

Q4 2020

Q1 2021

Q2 2021

Q3 2021

Q4 2021

No Partial Suspension Full Suspension Not Sure

Broker

Borrower Principal Contact Info

Co-borrower Information

Business Entity

Additional Guarantors

HMDA - (Borrower)

HMDA - (Co-Borrower)

Borrower Principal Background

Co-borrower Background

Borrower Principal Experience

Loan Amount Requested

Co-borrower Experience

SBA Questions

Other Business/Affiliate Information