Borrower Information

Broker Name:
Broker Address:

Borrower Information

Broker Fee:

PRIMARY BORROWER INFORMATION

Full Name:
Home Address:
Email:
Contact Number:

PRIMARY BORROWER INFORMATION

Employment:	Salaried Self Employed Other
Monthly income:
Total cash reserve:
Referred By:	James Melton Bruce Silverman Ken Melton
Your Credit Score:

SUBJECT PROPERTY INFORMATION

Subject Property Address:
Purchase Price or amount paid for refi:
Rehab needed or amount spent:
Loan Type:	Purchage Rehab Only Purchase only Cash Out Refinance Wholesale Flip Commercial

SUBJECT PROPERTY INFORMATION

Property Condition:	Excellent Average Poor Needs Rehab
SQ Ft:		Bed/bath:
Property Condition Comments:
Closing Date:

EXPERIENCE

Describe your experience in real estate:
What is your exit strategy from our Atlanta Private Lending loan:
How many properties do you own currently?:
How many projects have you completed in the past 12 months?:
Comments:

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