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Hard Money Lending Form Borrower Information First Name * Last Name * Phone * Email * Borrower's Address City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Foreign National or Citizen Foreign NationalCitizen Property Information Property Street Address Property City Property Zip Code Property State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Property Type ResidentialMulti-FamilyMixed-UseCommercial Loan Information Have You Ever Defaulted on a Loan? YN Have You Ever Filed a BK YN Have You Ever Been Convicted of a Felony YN Borrower's Net Worth <100,000100,000-150,000150,000-200,000200,000-250,000250,000-300,000300,000-350,000350,000-400,000400,000-450,000450,000-500,000500,000+ Purpose of Loan Fix & FlipFix and HoldFix & Flip RefinanceRental PurchaseGround-Up ConstructionResidential Bridge Loan Loan Amount <100,000100,000-150,000150,000-200,000200,000-250,000250,000-300,000300,000-350,000350,000-400,000400,000-450,000450,000-500,000500,000+ Desired Loan Term < 6 Months< 1 Year< 3 years< 5 years<15 years<30 years If Refinance, Existing Debt or any Back Taxes Against Property YesNo Refinance Existing Debt or Back Taxes Amount <100,000100,000-150,000150,000-200,000200,000-250,000250,000-300,000300,000-350,000350,000-400,000400,000-450,000450,000-500,000500,000+ Rehab Budget <100,000100,000-150,000150,000-200,000200,000-250,000250,000-300,000300,000-350,000350,000-400,000400,000-450,000450,000-500,000500,000+ Borrower's Business Information Borrower's Occupation Name of Borrowing Entity Are You The Guarantor YesNo Credit Score Excellent (720+)Good (660-719)Average (620-659)Below Average (580-619)Poor (579 and Lower) How Many Years Have You Invested in Real Estate How Many Transactions Have you Been Involved With If the Transaction is a Fix & Flip or Ground Up Construction Project (Residential or Commercial) Kindly List Your Executed Transactions Below. Real Estate Transactions Address Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Business / Entity Name Rehab Budget <100,000100,000-150,000150,000-200,000200,000-250,000250,000-300,000300,000-350,000350,000-400,000400,000-450,000450,000-500,000500,000+ Add Remove Hidden Sourceid 45 campaignid 7 groupid 39 opt_in Date Visited If you are human, leave this field blank. 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