Borrower Details Borrower Details

First Name

Last Name

Email

Property Address Property Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Phone Number

Are you applying: Are you applying: Purchase Refinance -R/T Refinance - Cash out

Are you applying for a Consumer or Business Purpose Loan Are you applying for a Consumer or Business Purpose Loan Consumer Business Purpose

Individual or Entity name

If Entity , % of ownership

Property type: ( condo, single family, condotel, 2-4 Unit, office, retail, mixed use , 5+ doors)

Owns Primary Residence Owns Primary Residence Yes No

Borrower/Partner Value Estimate :

Credit Score:

Requested Laon Amount

LTV:

Any Mortgage Events in the the last 12 months ( Ex: forbearance, missed payments, etc) Any Mortgage Events in the the last 12 months ( Ex: forbearance, missed payments, etc) Yes No

C-19 Forbearance C-19 Forbearance Yes No

Owns other investment properties ? Owns other investment properties ? Yes No