LOAN REQUEST SUBMISSION FORM

Submission by: Broker LO Processor Client Date:

Contact Name: Email:

Broker Company Name: Phone:

Borrower / Client Name:

Subject Property Address:

City: State: Zip:

Notes:

Loan Purpose: Proposed LTV:

(Cash out / ReFi / Purchase / Bridge / etc...)

New 1st Loan Amount Request: FICO:

Today's Property Value: Purchase Price:

(Total amount owed on subject property)

(Yes / No)

Subject Property: Property Type:

(Owner Occupied, Non Owner Occupied, Investment, Owner User, etc...) (1-4 unit, Commercial, Retail, Office, Land, SFR, etc...)

Subject Property Title:

Exit Strategy:
(Excellent, Good, Fair, Poor, Tear Down, etc...) (Plan for when loan term is up)

Use of Funds: (Taking Cash out? What will you be doing with it?)

Broker/LO Points Charged: Interest Reserve: Requested Loan Term:

(Yes / No) (6 mo, 1 year, 2 year, 3 year, 5 year, etc...)

Notes:

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