Commercial Lending Loan Submission Form

Date: Borrower:        
Is Borrower in Bankrupcy? Yes No            
Subject Address:          
City: State: County: Zip:
1st Mortgage Bal.: Date of Loan: In Foreclosure? Yes No
2nd Mortgage Bal.: Date of Loan:    
Purchase Price: Year Purchased:        
Property Value: How Determined?:        
Loan Amount Requested: LTV:        
  Refinance Purchase          
Property Type: Other        
Contact Person: Phone Number:        
Company: Fax Number:        
Street Address:          
City: State: County: Zip:
Email Address