Quick Application Form

Are you a referral Partner or Working with One?

Yes No

First Name

Last Name

Company Name

Phone Number

What kind of program are you looking for?

Broker/Referring Party

First Name

Last Name

Cell Phone

Is there a Co-signer?

Address

City

State

Zip Code

Yes No

Alternate Names

Alternate Section 1

First Name

Date Of Birth

Social Security #

Social Security Number

Unmarried Married Separated

U.S. Citizen Perm Resident Alien Non-Perm Resident Alien

Yes No

First Name

Last Name

Email Address

Cell Phone

Address

City

State

Zip Code

Yes No

Mailing Address

Personal Info

Date Of Birth

Social Security Number

Unmarried Married Separated

Yes No

U.S. Citizen Perm Resident Alien Non-Perm Resident Alien

Credit Score Range

Yes No N/A

Hispanic or Latino Not Hispanic or Latino Not Disclosed

Male Female Not Disclosed

Non-Veteran Veteran Service-Disabled Veteran Spouse of Veteran Not Disclosed

To Be Completed by Financial Institution (for application taken in person)

Yes No

The Demographic Information was provided through

Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet

Yes No N/A

Hispanic or Latino Not Hispanic or Latino Not Disclosed

Male Female Not Disclosed

Non-Veteran Veteran Service-Disabled Veteran Spouse of Veteran Not Disclosed

To Be Completed by Financial Institution (for application taken in person)

Yes No

The Demographic Information was provided through

Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet

Has the borrower been declared bankrupt within the past 7 years?

Yes No

Status of Personal Bankruptcy

Are there any outstanding judgments against the owners?

Yes No

(If Yes, Provide explanation below.)

Do you have any active lawsuits against you?

Yes No

(If Yes, Provide explanation below.)

Yes No

Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee

Yes No

(If Yes, Provide explanation below.)

Have you ever been convicted of a felony or other fraud related crimes?

Yes No

(If Yes, Provide explanation below.)

Has the borrower been declared bankrupt within the past 7 years?(If Yes, Do NOT proceed with application)

Yes No

Background Explanation

Are you a U.S. Citizen?

Yes No

Has the borrower been declared bankrupt within the past 7 years?

Yes No

Are there any outstanding judgments against the borrowers? (If Yes, Provide explanation below)

Yes No

(If Yes, Provide explanation below.)

Do you have any active lawsuits against you?

Yes No

(If Yes, Provide explanation below.)

Have you had or currently have any property tax liens?

Yes No

(If Yes, Provide explanation below.)

Yes No

Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee

Yes No

(If Yes, Provide explanation below.)

Have you ever been convicted of a felony or other fraud related crimes?

Yes No

(If Yes, Provide explanation below.)

Yes No

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address
City
State
Zip

Upload HUD

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address
City
State
Zip

Upload HUD

Property Type
Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address
City
State
Zip

Upload HUD

Yes No

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Monthly Rent

Sale Price

Sale Date

Address

City

State

Zip

Outcome/Profit

Upload HUD

Yes No

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Property Type

Purchase date

Purchase Price

Amount Financed

Rehab Budget

Entity Name

Ownership %

Exit

Address

City

State

Zip

Upload HUD

Yes No NA

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Yes No NA

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Yes No NA

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Address

Outcome/Profit

Upload HUD

Yes No NA

Yes No

Payroll Rent/Mortgage Interest Utilities Other

Have you, or any business you controlled, ever filed

Are you a referral Partner or Working with One?

Authorized Signer

Co-Signer Information

Business Entity

Additional Guarantors

HMDA - (Borrower)

HMDA - (Co-Borrower)

Owner/Signer Background

Co-Signer Background

Borrower Experience

Typical Transactions

Co-borrower Experience

Additional Information