BORROWER NAME *

First Name

Last Name

BORROWER PHONE NUMBER *

(###)

###

####

PROPERTY ADDRESS *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

BROKER NAME (IF APPLICABLE)

First Name

Last Name

BROKER PHONE NUMBER (IF APPLICABLE)

(###)

###

####

BROKER FEE (IF APPLICABLE)

50 BPS

.75 BPS

1 POINT

1.5 POINTS

2. POINTS

CLOSE DATE *

MM

DD

YYYY

LOAN TYPE *

Please check.

Acquisition-only Loan

Construction Loan

Construction-completion Loan

Inventory-financing Loan