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Broker Information
Broker Name
Broker Company
Email
example@example.com
Phone Number
Client Information
Client Name
Amount Requested
Facility Type
Principle and Interest
Principle and Interest with Balloon Payment
Interest Only
Bridging/Capitalised
Monthly Turnover - Current or Predicted
Security Address
Property Value #1
1st Mortgage Balance #1
Property Value #2
If applicable. If additional properties please include in notes below
Mortgage Value #2
Is there more than 1 mortgage with the same bank?
Yes
No
Purpose of the Loan/Additional Notes
Any supporting documents you wish to submit
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