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

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


Borrower Information
Name: (required)   
Co-Borrower:   
Phone:   
Email:   
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)   
County:   
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:   
Comments:   


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?