100 / 100 Intake Form
Entity "Type"
Please Select
LLC
LP
Corporation
Individual
Entity Name Entity Tax ID
Email
example@example.com
Phone Number
Please enter a valid phone number.
Website
Guarantor Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of Birth
-
Month
-
Day
Year
Date
SSN
Credit Score
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Do you RENT or OWN your current residence?
How long have you resided at this address?
Previous Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Did you RENT or OWN this residence?
How long did you reside here?
Employment Status
Self-Employed
Employee of a Company
Retired
If self-employed, percentage of business owned
If not self-employed, who is your employer
Current Position
Total Time On The job
Employer Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Monthly Income (Take Home)
Loan Amount Requested - Purchase Price ONLY
Requested Closing Date
-
Month
-
Day
Year
Date
Loan Term Requested
9 Months
12 Months
18 Months
24 Months
Property Type
SFH
2 - 4 UNIT
5+ UNITS
CONDO
MIXED USE
LOT / LAND
NEW CONSTRUCTION
Property Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Down Payment Amount
Rehab Amount
"As Is" Value
ARV
Original Cost
Title Company
Title Company Contact
First Name
Last Name
Title Company Email
example@example.com
Title Company Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Title Company Phone Number
Please enter a valid phone number.
Title Company Website
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of
Total LIQUID Assets Amount
Are there any outstanding judgements against you?
Yes
No
N/A
Have you, or any officer of your company, or any guarantor been involved in bankruptcy?
Yes
No
N/A
Have you ever been convicted of a felony?
Yes
No
N/A
Are you personally or is your business involved in any lawsuits or pending litigation?
Yes
No
N/A
Have you directly or indirectly been obligated on any loan of which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured(mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes," provide details, including date, name, and address of Lender, FHA or VA case number, if any, and reasons for the action.)
Yes
No
N/A
Details (If "YES" Only)
Are you, or your business, presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?
Yes
No
N/A
Are you obligated to pay alimony or child support?
Yes
No
N/A
Are you a guarantor, co-maker, or endorser for any debt of an individual, corporation, or partnerships?
Yes
No
N/A
Is any of your stated income likely to be reduced or interrupted within the next year?
Yes
No
N/A
Do you have any outstanding letters of credit or surety bonds?
Yes
No
N/A
Are there any lawsuits or legal actions pending against you?
Yes
No
N/A
Are you contingently liable on any lease or contract?
Yes
No
N/A
Are any of your tax obligations past due?
Yes
No
N/A
Are all of your personal and business’ tax obligations current?
Yes
No
N/A
Have you or your company ever used a private lender in the past?
Yes
No
N/A
Are you a U.S. citizen?
Yes
No
Are you a permanent resident alien?
Yes
No
Are any of the tax returns of any Party being audited or contested?
Yes
No
N/A
Is any Party related through a family, financial, voting or control interest in any of the other parties to the transaction for which you are applying for a loan; including, without limitation, sellers, lenders, Realtors, or settlement agents?
Yes
No
N/A
Will there be any other senior or subordinate liens or encumbrances on all or any portion of the subject property; including, seller carry-backs, second liens or other financing?
Yes
No
N/A
Is the subject property being purchased as part of a “flip” or “wholesale” transaction?
Yes
No
N/A
Are there any other partnerships, affiliate relationships, joint ventures, agreements, understandings, deals, side agreements, or other similar arrangements that will have an ownership or financial interest in all or any portion of the subject property?
Yes
No
N/A
Waive the right to receive a copy of the appraisal prior to signing loan documents?
Yes
No
N/A
Deal Description:
Exit Strategy:
Number of Years of Real Estate Experience
# of Properties Sold in The Last 5 Years
Deal Volume (In Dollars) of the Last 6 Months
Deal Volume (In Dollars) of the last 12 Months
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