Chaja Lending Services Submission Form

New Loan Submission Form
Loan Broker:
Submission Date:

MonthDayYear
Date
Closing Date:*

MonthDayYear
Estimated
Borrower Information:
Borrower Name*

First Last
First Name*
First
Last Name*
Last
Email*
example@example.com
Phone Number*

Area CodePhone Number
Credit Score:*
Co Borrower?*

YesNo
Property Information:
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Property Type:*

SFR2-4ApartmentCommercialRetailMixed UseLand
Occupancy:*

Owner OccupiedNon Owner Occupied
Loan Purpose:*

PurchaseRefinance
Loan Type:*
Purchase Price:*
Appraised Value:*
Rehab Budget:
Please provide full cost of rehab
After Repair Value:*
Loan Amount:*
Loan Balance:
Refinance Only!
Loan Term:*

6 Months1-3 Year Fixed5-7 Year Fixed10 Year Fixed30 Year Fixed
Investing Experience:*

No experience1-2 Deals3-5 Deals5+ Deals
Tell us about...*
Please be as detailed as possible.
Should be Empty: