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Please complete the form with as much information as possible.

Name

First Name

Last Name

Email Address

Phone

(###)

###

####

Property Address

Property City, State, Zip

Property Type

Use of Funds

REFINANCE, PURCHASE, REHAB, GROUND UP CONSTRUCTION, CASH OUT, BRIDGE LOAN

Property Current Value and/or Purchase Price

Rehab or Ground Up Construction Hard Costs

CAN BE ESTIMATED

After Repair / Completion Value

How many properties have you purchased in the past 12 months?

How many properties have you sold in the past 12 months?

Additional Collateral

Do you have property with significant equity that could potentially be used as additional collateral?