**Click here for the PDF downloadable version of this form.

Broker Information
Name: (required)    
Phone: (required)    
Email: (required)    

Borrower Information
Name: (required)    
Approximate Credit Score:    

Loan Information
Current Market Value of Property: (required)    
Loan Amount Requested: (required) $
Lien Position - 1st, 2nd or 3rd: (required)    
Loan-to-Value / CLTV: (required)     %
Loan Term - 60 days to 5 years: (required)    
Loan Program: (required)    
Property Type: (required)    
Occupancy: (required)    

Purchase Information
Purchase Price: $
Amount of Down Payment: $

Cash-Out Refinance
Amount of Cash Out: $
Purpose of Cash Out:    

Property Information
Property Street Address: (required)    
City, State Zip: (required)    
Amount owed on Subject Property: (required) $
If Refinance, what date was the property purchased?    
Original Purchase Price: $
Appraised Value or BPO Value: (required) $
Date of Appraisal or BPO:    

Underwriting Information
Reason(s) why borrower does not qualify for a Conventional Loan: (required)    

Pros and Cons
Strength of Transaction:    
Risk Factors:    

Ability to Pay
Borrower Income: (required) $
Co-Borrower Income: $
Other Income: $
Other: $

Loan Exit Strategy
Exit Strategy: (required)    
Sale of Property: (required)    
Target Sale Time Frame:    
Target Sale Price / After Repair Value: $
Has Loan been submitted elsewhere for approval? (required)    
Status or Outcome?