Client Information
Name:
E-Mail Address *
Phone
Subject Property Information
City, State & Zip
General Information
Loan Type:	Select From List Construction thru Permit Remodeler Spec
Number of projects are being contemplated?:*	Select From List 1 2 3 4
Loan Amount:*
Estimated Construction Cost:* (including plans & permits)
Estimated Current Value:
Estimated Completion Value:
Does the Borrower own the land?	Yes No
Lot Purchase Price:
Has the Borrower own the land for more than 12 months?	Yes No
Estimated pay off of land:
How much does the Borrower owe on the property:
When does the Borrower intend to close on the lot? (mmyyyy)
Does the Borrower plan to add square footage to the property?	Yes No
Does the Borrower have building permits?	Yes No
Declarations
Is Borrower willing to disclose his/her income?	Yes No
Is Borrower able to document his/her income?	Yes No
Is Borrower able to document his/her liquid assets?	Yes No
Is the Borrower a company?	Yes No
Company Name:
( * Required Fields )