General Information
Principal's Name*:
Company:
Address:
Phone*:
Fax:
E-mail*:
	Are you Using a Broker?

Broker's Name:
Company:
Address:
Phone:
Mobile Phone:
Fax:
E-mail:

Loan Particulars
Loan Amount*:
Address of Property*:
	Purchase Loan		Refinance Loan
	Is this a Construction Loan?

Purchase Price*:
Downpayment*:

Existing Debt*:
1st Mortgage Amount*:
2nd Mortgage Amount*:
Other Liens*:
As Is Market Value*:

As Improved Market Value*:
As-Improved Sale Value*:
for construction loans only, 4-6 Months

Use of Proceeds*:
Plan for Repayment*:
Misc Information
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Have You Spoken to a Loan Officer? If so Who?:
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mb# 0909936 Phone: 602-297-5151 Fax: 602-297-5152