Loan Application

Referring Broker Information

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* Email Address to be used to check the status of this application

Borrower Information

Borrower 1

* Full Name (or Business Name if Borrower is a Business)

Type

First Name

M.I.

Last Name

Country

Address

City

State

Zip Code

Email Address

Social Security #

Date of Birth

* Contact Phone #

Office Phone #

Marital Status

Loan Information

* Loan Amount Requested

Describe Use of Funds

Property Information

Property 1

* Description

Country

Address

City

State

Zip Code

Property Type

Estimated Market Value

After Repair Value (ARV)

Add Lien or Encumbrance

Acknowledgement & Agreement

DECLARATION OF NON-OWNER OCCUPANCY & BUSINESS USE OF PROCEEDS

* I ("Borrower") certify and represent to lender ("Originator") as follows: I hereby declare that I have no intention of making the property (subject property listed in my loan application) my principal residence. Additionally, I declare that I have no intention of utilizing the property as a second home and/or any surviving spouse or family member shall live in the property. I understand that this loan is a business purpose loan and not a household purpose loan. The loan proceeds are intended to be used and shall be used for business purpose only, not for personal use. I represent that I understand the difference between consumer loan for personal purposes and a commercial loan for business purposes. I represent that this loan is not a consumer loan and therefore is not subject to any laws relating to consumer loans under any state or federal laws such as Truth in Lending Act (15 U.S.C §§ 6802-8809). Secure and Fair Enforcement Mortgage Licensing Act (12 U.S.C. § 5101 et seq.), and Homeowners Protection Act (12 U.S.C. § 4901 at seq.). I realize the lender, broker, assignees,and successors rely upon this information. I confirm I have read and understand this document. I declare that under penalty of perjury the foregoing is true and correct.

AUTHORIZATION TO CONDUCT CREDIT & BACKGROUND CHECK

* By signing this form. I/we hereby authorize the lender to conduct a background and/or credit check. Additionally, the undersigned and each party to this loan, authorizes lender to disclose to any third party, employee, agent or assignee thereof information regarding my reported background and credit history. I understand that it is a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statement when applying for this mortgage, as applicable under the provisions of title 18, united states code, 1014. I also understand that the lender intends to use the data obtained through the investigation for due diligence purposes only and shall not disclose such information to any other party.

A FACSIMILE, ELECTRONIC OR OTHER COPY OF THIS SIGNED AUTHORIZATION SHALL BE AS VALID AS THE ORIGINAL.

* Applicant 1 Signature (Type Initials)

* Applicant 1 Printed Name

* Date

Note: All questions marked with a red asterisk (*) are required to complete the application.