Borrower Name
Borrower Address
Borrower City
Borrower State
Borrower Zip
Borrower Telephone
Borrower Fax
Borrower E-mail
Exact Name of Property
Property Address
Property City
Property State
Property Zip
Type of Property (motel, shopping center, garage, etc.)
Square Footage of Property or Number of Units
Amount of Loan Requested ($500,000.00 minimum.)
Addtional Comments