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

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

Borrower Information
Borrower: (required)   
Principal Residence Street: (required)   
Principal Residence City: (required)   
Principal Residence State: (required)   
Principal Residence Zip: (required)   
Approximate Credit Score: (required)   

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

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

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

Subject Property Information
Street Address: (required)   
City, State Zip:   
Property Type:   
Amount owed on Subject Property:$
Estimated Value or BPO Value: (required)$
*California only

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

Loan Exit Strategy
Exit Strategy:   

Rehab Questions
$ Amount of Rehab Planned:   
Target Sales Price / After Repair Value (ARV): (required)