Quick Application Form

Loan Officer/Mortgage Broker

Yes No

What kind of program are you looking for?

Where are you in the process?

Lead Source

Client Info

First Name

Last Name

Client Email

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Home Phone

Cell Phone

Address

City

State

Zip Code

Yes No

Mailing Address

Alternate Names

Alternate Section 1

First Name

Personal Info

Date Of Birth

Social Security Number

Unmarried Married Separated

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

Yes No

Credit Score Range

Co-borrower Information

First Name

Last Name

Email Address

Please Wait...

Cell Phone

Mobile Service Provider

Yes No

Mailing Address

Personal Info

Unmarried Married Separated

Yes No

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

Credit Score Range

Business Entity

General Business Info

Entity Name

Trade Name/DBA

State Of Formation

Federal Tax ID/EIN

Business Phone

Business Address

Address

City

State

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.)

Yes No

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

Yes No

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

Yes No

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

Yes No

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

Yes No

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

Yes No

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

Yes No

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

Yes No

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

Yes No

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

Yes No

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

Add More Members/Officers Info

Additional Guarantors

Yes No

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

HMDA - (Borrower)

Yes No N/A

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

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

Male Female Not Disclosed

an option for veteran

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

HMDA - (Co-Borrower)

Yes No N/A

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

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

Male Female Not Disclosed

an option for veteran

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

Client Background

Yes No

Co-borrower Background

Yes No

Borrower Experience

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

Yes No

# of years of experience?

# of properties completed in last 36 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

Does borrower have ground up construction experience?

Yes No

# of years experience?

# of properties completed in last 36 months

List 3 examples of past projects:

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

Address

City

State

Zip

Outcome/Profit

Upload HUD

Yes No

Typical Transactions

Co-borrower Experience

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

Yes No