Borrower  or Company Name

 Borrower Phone#     Mobile    Fax   

                  E-Mail

PROPERTY INFO

Property Address   Mapsco/Key   Occupied?

 City County   Zip        

 Legal Description

Property Access?     Currently own the Property?  Yes   No      

Expected time frame for completion & re-paying this loan:

DESCRIPTION OF PROPERTY & PURCHASE INFO

 Sq. Ft. Living Area:   Garage Conversion and/or Add-ons?

 Is tax info on sq. footage correct?   If not, explain

Bedrooms/Bath/Garage           Exterior:  Brick  Frame  Other

Approx Year Built     Style of House    Foundation Type

Current:   Air Select One Central Window None   Heat Select One Central Gas Central Electric Wall Floor Furnace None                Roof Type

Proposed: Air Select One Central Window None   Heat Select One Central Gas Central Electric Wall Floor Furnace None                Approx Age of Roof

Purchase Price of Property:      Expected Rehab Cost:    

1-year Insurance Cost  Have agent call Heather @ x-7 for Mortgagee info

Approx Closing Cost                   Requested Loan Amount

Expected After Repaired Value             Expected Profit          

Sales price is based on (select one):      Appraisal    Comps    Realtor   Other

Please check the program you would like to have (refer to website for details):

1 year, 18%        6 month, 16%        1 month, 14%

Title Co.Contact

 Address

 Phone     Fax