Quick Application Form

Loan Officer

Yes No

Are you working with someone in our office already?

Yes No

Who are you working with?

Email Address

First Name

Last Name

Company Name

Phone Number

What kind of loan do you need?

Where are you in the process?

How did you hear about us?

Referring Person (if there is one)

Borrower Info

First Name

Last Name

Borrower Email

Please Wait...

Best Phone Number

Cell Phone

Cell Carrier

Is there a Co-borrower?

Address

City

State

Zip Code

Length of time at present address

Rent or Own

Have you lived at your present address for less than two years?

Yes No

Previous Address

Previous City

Previous State

Previous Zip Code

Length of time at the previous property

Rent or Own

Mailing Address

Mailing Address same as Current Address?

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Alternate Names

Alternate Section 1

First Name

Personal Info

Date Of Birth

Social Security Number

Driver License State

Driver License Number

Marital Status?

Unmarried Married Separated

Maiden Name

Full name of Spouse

Citizenship

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

Yes No

Credit Score Range

Co-borrower Info

First Name

Last Name

Email Address

Please Wait...

Best Phone Number

Cell Phone

Same as borrowers address?

Address

City

State

Zip Code

Rent or Own

Length of time at present address

Has the co-borrower lived at their present address for less than two years?

Yes No

Previous Address

Previous City

Previous State

Previous Zip Code

Mailing Address

Same as borrowers mailing address?

Mailing Address

Mailing City

Mailing State

Mailing Zip

Personal Info

Date Of Birth

Social Security Number

Driver License State

Driver License Number

Marital Status?

Unmarried Married Separated

Married to Borrower?

Yes No

Citizenship

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

Credit Score Range

Business Entity

General Business Info

Entity Name as registered with the state

Entity Type

Date Of Formation

State Of Formation

Federal Tax ID/EIN

Business Address

Address

City

State

Zip Code

Is the billing address the same as above?

Billing Address

Billing City

Billing State

Billing Zip Code

Urban Rural Suburban

Business Details

NAICS Code look up

Service Product

B2B B2C

Yes No

Business Financials

Yes No

Members/Officers (List all members with 20% ownership or more.)

Same as Borrower/Applicant Info Above

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Credit Score

Drivers License State

Drivers License

Yes No

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

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Credit Score

Drivers License State

Drivers License

Yes No

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

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Credit Score

Drivers License State

Drivers License

Yes No

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

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Credit Score

Drivers License State

Drivers License

Yes No

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

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Credit Score

Drivers License State

Drivers License

Yes No

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

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Credit Score

Drivers License State

Drivers License

Yes No

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

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Credit Score

Drivers License State

Drivers License

Yes No

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

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Credit Score

Drivers License State

Drivers License

Yes No

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

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Credit Score

Drivers License State

Drivers License

Yes No

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

Name

Title

% of Ownership

Address

Phone

Cell

SSN

DOB

Credit Score

Drivers License State

Drivers License

Yes No

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

Add More Members/Officers Info

Sales Method

Fee Schedule

Equipment Info

Yes No

Additional Guarantors

Are there any additional guarantors?

Yes No

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

Guarantor Notes

HMDA - (Borrower)

Do you wish to furnish this information?

Yes No N/A

What is your Ethnicity:

Hispanic or Latino

Mexican, Puerto Rican, Cuban, Other Hispanic or Latino

Mexican Puerto Rican Cuban Other Hispanic or Latino

Print Origin For example: Argentinean, Colombian, Dominican, Nicaraguan,Salvadoran, Spaniard, and so on

Not Hispanic or Latino Not Disclosed

What is your Race:

American Indian or Alaska Native Asian

Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian

Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian

Print Race For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.

Black or African American Native Hawaiian or Other Pacific Islander

Native Hawaiian, Guamanian or Chamorro, Samoan, Other Pacific Islander

Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander

Print Race For example: Fijian, Tongan, and so on.

White Not Disclosed

Sex:

Male Female Not Disclosed

Veteran an option for veteran

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

HMDA - (Co-Borrower)

Do you wish to furnish this information?

Yes No N/A

What is your Ethnicity:

Hispanic or Latino

Mexican, Puerto Rican, Cuban, Other Hispanic or Latino

Mexican Puerto Rican Cuban Other Hispanic or Latino

Print Origin For example: Argentinean, Colombian, Dominican, Nicaraguan,Salvadoran, Spaniard, and so on

Not Hispanic or Latino Not Disclosed

What is your Race:

American Indian or Alaska Native Asian

Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian

Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian

Print Race For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.

Black or African American Native Hawaiian or Other Pacific Islander

Native Hawaiian, Guamanian or Chamorro, Samoan, Other Pacific Islander

Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander

Print Race For example: Fijian, Tongan, and so on.

White Not Disclosed

Sex:

Male Female Not Disclosed

Veteran an option for veteran

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

Borrower Background

Are you a U.S. Citizen?

Yes No

Have you, or any entity in which you are a part, declared bankruptcy within the past 7 years?

Yes No

Status of Personal Bankruptcy

Please provide filing date, current status, properties included, etc...

Are there any outstanding judgements against you or any entity in which you are a part?

Yes No

(If Yes, Provide explanation below.)

Do you have any active lawsuits against you or any entity in which you are a part?

Yes No

(If Yes, Provide explanation below.)

Do you, or any entity in which you are a part, have any past due Property Taxes?

Yes No

(If Yes, Provide explanation below.)

Have you, or any entity in which you were a part, had any loan that was foreclosed, or transferred via a Deed in Lieu of foreclosure?

Yes No

Status of Foreclosure

(If Yes, Provide explanation below.)

Are you, or any entity in which you are a part, currently delinquent or in default on any debt, loan, mortgage, or financial obligation?

Yes No

(If Yes, Provide explanation below.)

Have you ever been convicted of a felony or other fraud related crimes?

Yes No

(If Yes, Provide explanation below.)

Yes No

Any additional Background Explanation

Yes No

Co-borrower Background

Are you a U.S. Citizen?

Yes No

Have you, or any entity in which you are a part, declared bankruptcy within the past 7 years?

Yes No

Please provide filing date, current status, properties included, etc...

Are there any outstanding judgements against you or any entity in which you are a part?

Yes No

(If Yes, Provide explanation below.)

Do you have any active lawsuits against you or any entity in which you are a part?

Yes No

(If Yes, Provide explanation below.)

Do you, or any entity in which you are a part, have any past due Property Taxes?

Yes No

(If Yes, Provide explanation below.)

Have you, or any entity in which you were a part, had any loan that was foreclosed, or transferred via a Deed in Lieu of foreclosure?

Yes No

(If Yes, Provide explanation below.)

Are you, or any entity in which you are a part, currently delinquent or in default on any debt, loan, mortgage, or financial obligation?

Yes No

(If Yes, Provide explanation below.)

Have you ever been convicted of a felony or other fraud related crimes?

Yes No

(If Yes, Provide explanation below.)

Yes No

Background Explanation

Borrower Experience

Does borrower have Fix & Flip or Buy & Hold experience?

Yes No

# of years of experience?

# of properties sold in last 24 months

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

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