LOAN INQUIRY FORM

Broker Information

Referring Broker Rep:
E-mail
Referral Fee:
Broker #:
Phone:
Fax
To
Name of Broker on License
Address
borrower
Name :
Home Phone
Fax:
Home Address
Social Security #
Date of Birth
Married:
yes no
Name and Address of Employer:
Type of Business/Position
Monthly Income:
Vesting on Title
Loan Information
Subject Property Address
Requested Gross Loan
Net Cash Out
Purchase Date
Position :
1 st
Rate
Prepayment 1yr
Estimated Value
 
2 nd
Term
Price
     
Points
         
Loan Purpose :

Loans Presently Against the Property

Position
Orig.Amt
Amt.Due.
Rate
Paymt
Term
B'loon
Nod
Bring Current
1st
2nd
3rd

Property Description

SFR:
  Commercial   Other
Condo
   Office      
Units: #
  Retail      
Land
   Mixed Use      
APN #
  Industrial      
             
Lot SF
Building SF
Owner Occupied
Vacant
Rental
# units
# occupied
Monthly Gross Rental Income
For Sale ?
Price