Information Request Form
First Name
Last Name
Mailing Address
City
State
Zip Code
Property Address (if different)
Email Address
Home Telephone
Work Telephone
Fax Telephone
Amount Of Loan Needed
Type Of Property As Collateral
Single Family Residence Duplex Triplex Quadruplex Commercial Mixed Use Apartment Vacant Land Church
Property Purchase Date
Property Purchase Price
Value Of Property
Is There A Current Appraisal
No Yes
Monthly Gross Rents (income properties)
1st TD
1st TD Lender
2nd TD
2nd TD Lender
3rd TD
3rd TD Lender
Borrower's Credit
Very Good Good Average Poor Very Poor
Bankruptcies
Judgements
Borrower's Monthly Income
Comments, Questions, Suggestions