Full Application
Useful Documents
Rehab Budget
Useful Documents
Rehab Budget
General Info
Initial Loan App Setup
Applicant Info
Borrower & Guarantor Info
Background & Experience
Disclosures, track record & misc questions.
Borrower Financials
Detailed financials (if Applicable)
Loan & Property/Collateral
Collateral details supporting the loan
Additional Information
Detailed questions to finalize the loan
Loan Officer/Mortgage Broker
Are you a Mortgage Broker or working with one?
Yes
No
Please select your Mortgage Broker
- Select / New -
Aaron Levy
Aaron Sanders
Adam Berg
Al Jones
Alan Freeman
Alex Tatem
Alicia Endley
Allen Mario
Allen Wu
Althea Williams
Amos Benjamin
Ana Marshall
Andrew Seeker
Andy Almazan
Angela Bove-Sutphen
Angela Mayes
Anthony Quinn
Antone Foster
Antonio Gutierrez
ARNOLD MITCHELL
Aryan Kini
Barak Levin
Ben Vogler
Bennett Abel
Bob O'Connell
Bonnie Casey-Moore
Bradley Ousley
Brandon Davis
Brandon Stewart
Brandyn Armstrong
Brent Howells
Brian Siegel
Bryce Noel
Byron Enriquez
Camlee Bella
Carlo Desierto
Carlos Arrieche
Carol Junge
Cassandra Dorsainvil
Catherine Cotay
Cedrick Ford-Phillips
Cenaca Cyprian
Chance Cessna
Cherie Fields
Cherri Anderson
Chidiebere Chimexie
Chris Doster
Christopher Cook
Christopher Daniels
Christopher Perez
Christopher Perez
CJ Brigham
Correspondent Chris
Cory Walker
Craig DeMaio
Crystal Perry-Thompson
Dallas O'Cannon
Dalton Cason
Danielle Matlin
Danny Davila
Dario Lopez
Darren Lynch
Darrion Williams
David Baquera
David Graham
David Jameson
Dawn Kern
Dawn Robbins
Dee Dee Stewart
Derric Goss
Don Carr
Don Hill
Donna Stogner
Doris Goulet
Dustin Gomes
Dwayne Bull
Dwight McCaulsky
Eboni Mills
Edward Clark
Edward Hyson
Edward Kaufman
Elias Altamirano
Eliezer Yousufov
Eric Hannah
Eric Stewart
Erica Walker
Ericka Abrams
Evie Hirschmann
FBS Commercial Capital FBSLLC
Francesco Sergio
Frank Lewis
Fund it Realty r
Garry Cornelius
Gary Allen Couch
Genevah Bawah
George Sykes
Global Integrity Finance GIF
Greg De Minco
Guy Godboldo
Harvey Hackerman
Helene Charles
Holly Peterson
Howard Stokes
Ike Bradley
Ikesha Russell
Isaac Morgenstern
Jacob Abraham
Jacqueline Brooks
James Lee
James Rachel
Jamie Torres
Janna Birdwell
Jason Hannah
Jason Hannah
Jason Shaw
Jason Watson
Jay Parker
Jeff Soderstrom
Jennifer Fey
Jerrod Leathers
Jerry Price
JM Real Estate Capital _
Jodey Thomas
Jodi McNamara
Joe Novak
Joel Jackson
John Barton
John Raymer
John W Springer
Johnnie Poole
Johnny Previlus
Jonah Goldberg
Jordan Key
Jordan Weimersheimer
Jose Gutierrez
JUAN ANTONIO RUIZ DE VELASCO
Julio Guerrero
Justin Frye
JW Capital Group, LLC
Karen Wood
Kawika K. Burgess
Keco Capital Cory/Alexander
Keenon Giles
Kelly Montgomery
Kelvin Williams
Kenneth Phillips
Kevin Gray Sr
Kewana Reese
Khemraj Sarju
Kip Myers
Kira Staggers
Lance Graham
Laura De Loera
Lauren Stevens
Lea Coston
Lee Anthony
Legacy One Group LLC
Lisa Florenzen
Louis Wanshura
Magis Funding
Malcolm Turner
Mariel Phang
Mark Elkins
Mark Hyland
Mark Williams
Marques BROWN
Marquita Howard
Marshall Horner
Marty Johnson
Matthew Mesick
Maurice Federbusch
Megan Krache
Meir Spaeth
Michael Mills
Michael Stewart
Michael Valladares
Michelle England
Michelle Hugee
Mike Callis
MIke Moriarty
Monica Victorino
Mufid Farha
Myeshia Baker
Neemota Rufai
Nelson David
Nick Belsky
Nick Cosmas
Nick Covington
Nicolaas Thielman
Nicole Vogiatzis
Parnell Jackson
Parthasarthy Rajarathinam
Patrick Fisher
Patrick Harris
Paul Metz
Percy Lowe
Peter Burgess
Phil Gustin
Rachel Sheehan
Raja Maan
Randall Rousse
Randy Carty
Raquel Myers
Ray Hamilton
Ray Knox
Regine Daley
Renita Lakey
Residential Capital Partners
Rich Johnson
Rich Thomas
Richard Nordlund
Riley Stogner
RJ Mainardi
Robert O'Connell
Roderick Williams
Roger Lo
Ronald Mangie III
Roy Ornelas
Roy Sell
Rudolph Pierre
Ryan Alford
Sam Harris
Sam Lun
Sam MacDonald
Samuel Stevens
Scott Allen
Sean Troncoso
Selena Arms
Shahzad Ahmad
Shauni Siu
Shaunte Porter
Shawna Wyatt
Sheree Jones
Sherman Cowley
Shirlean Jefferson
Soraya Aubele
Stacie Stewart
Steve Johnston
Steven Barsolona
Steven Hobbs
Sunny Nyemah
Suzette Bethea
Sylvester Allison
syreeta Williams
Tamika Wise
Terence Young
Terrence Drakes
The Firm Lending a
Timothy Harvilla
Timothy Thomas
Toby Rippetoe
Toby Watson
Tom Fritz
Toni Whitaker Osborn
Tony Payton
Trae'Vorris Canaday
Trichelle Hardy
Tristian Denha
Verna McKain
Vernon Lesser
Vicki Nelson
Vontrick Davidson
Wanda Sweat
William McCormick
Willie Ingram
Xavier Hall
Xiomara Jabbar
Yumie Payne
Yvette Freeman
Email Address
First Name
Last Name
Company Name
Phone Number
Are you a Loan Officer or working with one?
Yes
No
Email Address
First Name
Last Name
Company Name
Phone Number
Product Group
- Select -
Bridge Loan
Rental Loan
SBA Loan product
SBA 7a
SBA 504
Micro Loan
SBA Express
CAP Line
Community Advantage
SBA Veterans Advantage
International Trade
Export Working Capital
Export Express
Payroll Protection Program
EIDL
:
Bridge Loan
Rental Loan
Where are you in the process?
- Select -
Looking for General Info
Actively Looking For Property
Identified a Property
Have Property Under Contract
I Own The Property/Land
How did you hear about Our firm?
- Select -
Google Search
Return Customer
Referral from Realtor
Referral from Current Customer
REIA Meeting
Referral from Broker
Lava Cantina or other GIF Sponsored event
Other
Other
Broker/Referring Party
Guarantor Info
First Name
Middle Name
Last Name
Borrower Email
Please Wait...
Secondary Email
Home Phone
Cell Phone
Fax
Cell Carrier
- Select -
AllTel
ATT
Cingular
Cricket
H20
Metro PCS
Boost Mobile
Nextel
Sprint PCS
Straight Talk
T-Mobile
Tracfone
US Cellular
Virgin Mobile
Verizon
Preferred Communication
Phone
E-mail
Text
Web Portal
Is there a Co-borrower?
Alt. Phone #
Work Phone #
Address
Unit #
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
County
- Select -
Country
- Select -
United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.s.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Number of years at present address
Length Of Time At The Present Property Months
Rent or Own
- Select -
Own
Rent
Rent Per Month Current Address
Has the borrower resided at the present address for less than two years?
Yes
No
Previous Address
Previous Unit #
Previous City
Previous State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Previous Zip Code
Previous Country
- Select -
United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.s.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Number of Years at the previous property
Length Of Time At The Previous Property Months
Number of Years at Address ?
Rent or Own
- Select -
Own
Rent
Rent Per Month Previous Address
Mailing Address
Mailing Address same as Current Address?
Same as Property Address?
Mailing Address
Mailing Address Unit#
Mailing City
Mailing State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip Code
Mailing Address Country
- Select -
United States
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the Congo
Cook Islands
Costa Rica
Cote D Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and Mcdonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic Peoples Republic of
Korea, Republic of
Kosovo
Kuwait
Kyrgyzstan
Lao Peoples Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the Former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.s.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
- Select -
Own
Rent
Alternate Names
Alternate Section
1
First Name
First Name
First Name
Personal Info
Date Of Birth
Place Of Birth
Social Security Number
Driver License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Driver License Number
Driver License Issuance Date
Driver License Expiration Date
Marital Status?
Unmarried
Married
Separated
Date of Marriage
Date of Divorce (If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Did you ever serve, OR are currently serving IN the United States Armed Forces?
Yes
No
Servicing member Info
Currently serving on active duty
Currently retired,discharged, or separated from service
Only period of service was as a non-activated member of the Reserve or National Guard
Surviving Spouse
Projected Expiration Date of Service/Tour
Ages Of Dependents
Number Of Dependents
Credit Score
Equifax Score
Transunion Score
Experian Score
Credit Score Range
- Select -
720 +
680 - 719
620 - 679
600 - 619
580 - 599
580 or Below
Foreign National- No Score
Co-Guarantor Info
First Name
Last Name
Email Address
Please Wait...
Home Phone
Cell Phone
Fax
Mobile Service Provider
- Select -
AllTel
ATT
Cingular
Cricket
H20
Metro PCS
Boost Mobile
Nextel
Sprint PCS
Straight Talk
T-Mobile
Tracfone
US Cellular
Virgin Mobile
Verizon
Same as borrowers address?
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Rent or Own
- Select -
Own
Rent
Is the Co-Borrower Guaranteeing the loan?
Yes
No
NA
Number of years at present address
Has the coborrower resided at the present address for less than two years?
Yes
No
Previous Address
Previous City
Previous State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Previous Zip Code
Number of Years at Address ?
Rent or Own
- Select -
Own
Rent
- Select -
Own
Rent
Mailing Address
Same as borrowers mailing address?
Mailing Address
Mailing City
Mailing State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip
- Select -
Own
Rent
Personal Info
Date Of Birth
Place Of Birth
Social Security Number
Driver License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Driver License Number
Driver License Issuance Date
Driver License Expiration Date
Marital Status?
Unmarried
Married
Separated
Married to Borrower?
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Equifax Score
Mid Fico Score
Transunion Score
Experian Score
Credit Score Range
- Select -
720 +
680 - 719
620 - 679
600 - 619
580 - 599
580 or Below
Foreign National- No Score
Borrower Type/Entity Info
Borrower Type
- Select -
Individual
Entity
Trust
Retirement Entity
Trust Type
- Select -
Revocable
Irrevocable
Retirement Entity
- Select -
Self-Directed IRA
Self-Directed 401K
IRA LLC
General Business Info
Entity Name
Trade Name/DBA
Entity Type
- Select -
Sole Proprietorship
Limited Partnership
General Partnership
LLC
Corp
S-Corp
Self Employed-1099 Contractor
501 (c)(3) Nonprofit
501 (c)(19) Veterans Org
Tribal Business
Trust
Joint Venture
Estate
Other
Member
Partner
Shareholder
Managing Member
Date Of Formation
Time in Business
Less than 3 Months
3-6 Months
6-12 Months
1-2 Years
2-3 Years
3-5 years
5+ years
State Of Formation
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
States Registered In
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Federal Tax ID/EIN
Business License Number
Issuance Date
Expiration Date
State Issued
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other States Operating In
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
DBA Name(s)
Prior Business Name(s)
Organizational Ref #
Business Phone
Website Address
Business Address
Start Date at Location
Address
Address 2/Suite/Unit #
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Is the billing address the same as above?
Billing Address
Billing City
Billing State
-Select-
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Billing Zip Code
Location
Urban
Rural
Suburban
Property Ownership
- Select -
Own
Rent
Value of Property?
$
Total Debt on Property?
$
Name of Lender(s)?
Landlord/Mortgage Contact Name
Landlord/Mortgage Phone
Rent/Mortgage Payment
Business Details
Business Type
- Select -
Mobile & E-Commerce
Retail
Home Improvement
Food & Beverage
Travel and Tourism
Transportation
Meetings and Events
Education
B2B
Healthcare
Government
Non-Profit
Entertainment
Lodging
Legal
Salon & Spas
Professional Services
Other
# of employees currently
# of employees after loan
Business Category
- Select -
Agriculture,Forestry,Fishing
Construction
Manufacturing
Transportation & Public Utilities
Whole Sale Trade
Retail Trade
Finance Insurance Real Estate
Services
Public Administration
Utilities
Transportation and Warehousing
Professional, Scientific,Tech Services
Educational Services
Health Care and Social Assistance
Arts,Entertainment,Recreation
Restaurant,Internet,Mail Order/Telephone Order
Type of product or service sold
Naics Code
NAICS Code look up
Does your business sell a
Service
Product
Is your Business
B2B
B2C
Is your business home based?
Yes
No
Do you take credit card payments?
Yes
No
Terminal/ POS Make/Model
How many card processor banks do you have active?
Merchant Processing Bank Name(s)
Do you charge sales tax?
Yes
No
How are employees paid?
- Select -
W-2
1099
W-2 & 1099
Cash
Do you have more than one business location?
Yes
No
How many locations?
Other Location Details & Addresses
Is the business a franchise?
Yes
No
Name of Franchise
Point of Contact
Point of Contact Phone
Point of Contact E-mail
Website for Franchise
is your business seasonal?
Yes
No
if Yes, what are the peak months?
Business Description
Do you have Business Reference(s)?
Yes
No
1
)
Phone Name
Company
Fax
Email
Business Financials
Average Monthly Credit Card Sales
$
Average Monthly Deposits
$
Annual Revenue
$
Annual Gross Profit
$
YTD-Net Business Income
$
Date of Operating Agreement
Gross Annual Revenues $
$
Gross Income Last Year
$
Net Income Last Year
$
Gross Income 2 years ago
$
Net Income 2 years Ago
$
Average Bank Balance
$
Has business ever filed for bankruptcy?
Yes
No
Status of Business Bankruptcy
Still Active
Discharged- 1 month
Discharged- 1-3 months
Discharged- 3-6 months
Discharged- 6-12 months
Discharged-1 year
Discharged- 2 years
Discharged- 3 years
Discharged- 5 years
Discharged-7+ years
Recent NSFs
0
1
2
3
4
5
6
7
8
9
10+
Does your business owe taxes for years prior to the current year?
Yes
No
Estimated amount owed
$
Members/Officers
(List all members with 20% ownership or more.)
Same as Borrower/Applicant Info Above
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Contact Phone #
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Contact Phone #
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Contact Phone #
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Contact Phone #
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Contact Phone #
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Contact Phone #
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Contact Phone #
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Contact Phone #
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Contact Phone #
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Name
Title
% of Ownership
%
Annual Salary/Compensation
Address
Phone
Contact Phone #
SSN
DOB
Credit Score
Email
Marital Status
Unmarried
Married
Separated
Date of Marriage
Date of Divorce(If applicable)
Maiden Name
Full name of Spouse if not on mortgage
Drivers License State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Drivers License
Member TIN
Personal Guarantee for this loan
Yes
No
Authorized signer for making loans
Yes
No
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Add More Members/Officers Info
Corporate Secretary Name
Notes
Additional Guarantors
Are there any additional guarantors?
Yes
No
First Name
Middle Name
Last Name
Phone #
Contact Phone #
SSN
Date Of Birth
Marital Status?
-Select -
Single
Married
An Entity
Divorced
Widowed
Address
City
State
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip
Email
Credit Score
Citizenship
U.S. Citizen
Perm Resident
Non-Perm Resident
Foreign National
Guarantor Notes
General 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
Non-Veteran
Veteran
Service-Disabled Veteran
Spouse of Veteran
Not Disclosed
Guarantor Background
Are you a U.S. Citizen?
Yes
No
Origin
Visa Status
Has the borrower been declared bankrupt within the past 7 years?
Yes
No
Status of Personal Bankruptcy
Still Active
Within 1 month
1-3 months
3-6 months
6-12 months
1 year
2 years
3 years
4 years
5 years
7+ years
If Yes, identify the types of bankruptcy
Chapter 7
Chapter 11
Chapter 12
Chapter 13
Please provide filing date, current status, properties included, etc...
Are there any outstanding judgments against the borrowers?
Yes
No
(If Yes, Provide explanation below.)
Do you have any active lawsuits against you personally or any entities you are a part of?
Yes
No
(If Yes, Provide explanation below.)
Have you had or currently have any property tax liens?
Yes
No
(If Yes, Provide explanation below.)
Has the borrower directly or indirectly been obligated on any loan which resulted in foreclosure, pre-foreclosure, transfer of title in lieu of foreclosure, or judgement?
Yes
No
Status of Foreclosure
Still Active
Within 1 month
1-3 months
3-6 months
6-12 months
1 year
2 years
3 years
4 years
5 years
7+ years
(If Yes, Provide explanation below.)
Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee
Yes
No
(If Yes, Provide explanation below.)
Have you ever been convicted of any felony or any other fraud related crimes? (If Yes, a detailed signed LOE is required from client prior to file submission.)
Yes
No
(If Yes, Provide explanation below.)
Are you in a Civil Union or a Domestic Partnership, or do you have a non-borrowing spouse, or are you a party to a Designated Beneficiary Agreement?
Yes
No
(If Yes, Provide explanation below.)
Within the past 7 years, have you completed a pre-foreclosure sale, whereby the property was sold to a third party and the Lender agreed to accept less than the outstanding mortgage balance due?
Yes
No
Have you had property foreclosed upon in the last 7 years?
Yes
No
Have you previously had a short sale?
Yes
No
When was the short sale?
Please explain the circumstances of the short sale
Background Explanation
Income tax returns filed through
Are any returns currently being audited or contested?
Yes
No
what years (s)
Have you drawn a will?
Yes
No
Please furnish the name of the executor(s) and year will was drawn
Have you ever had a financial plan prepared for you?
Yes
No
Is there a line of credit or unused credit facility at any other institution(s)?
Yes
No
Please indicate where, how much, and name of banker
Do you anticipate any substantial inheritances?
Yes
No
Please Explain
Co-Guarantor Background
Are you a U.S. Citizen?
Yes
No
Origin
Visa Status
Has the borrower been declared bankrupt within the past 7 years?
Yes
No
Please provide filing date, current status, properties included, etc...
Are there any outstanding judgments against the borrowers? (If Yes, Provide explanation below)
Yes
No
(If Yes, Provide explanation below.)
Do you have any active lawsuits against you personally or any entities you are a part of?
Yes
No
(If Yes, Provide explanation below.)
Have you had or currently have any property tax liens?
Yes
No
(If Yes, Provide explanation below.)
Has the borrower directly or indirectly been obligated on any loan which resulted in foreclosure, pre-foreclosure, transfer of title in lieu of foreclosure, or judgement?
Yes
No
(If Yes, Provide explanation below.)
Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
Yes
No
(If Yes, Provide explanation below.)
Have you ever been convicted of any felony or any other fraud related crimes? (If Yes, a detailed signed LOE is required from client prior to file submission)
Yes
No
(If Yes,