Personal Information

Contact Person:

Note Holder/Applicant  Broker  Other:
*

Email:

*

Phone:

*

Fax:

Project:
(For easy identification please insert a title for your project.  Example: Sunset Cleaners or Rainbow Printing

Project Information

Original Selling Price:

Down Payment:

Original Note Balance:

Months / Years Financed:

Interest Rate:

Monthly Payment:

Balloon:

   Yes   No

if yes, date:

Amount:

Date of First Payment:

Remaining Payment:

Current Balance:

Credit of Payer:

   --------- Excellent Good Bad Unknown

Type of Business:

  Apartment Assisted Living Auto Repair Auto Dealership Bed and Breakfast Inns Casino Church Commercial or Retail Congregate Care Facility Gas Station Golf Course Hotel-Motel Industrial Buildings Land Medical Building Mini-Warehouses Mixed Use Mobile Home Park Multi-Family 5+ units Office Building Restaurants Shopping Centers Special Use Properties

How Long in Business:

Is Operation a Franchise:

   Yes   No

Is Note Personally Guaranteed:

   Yes   No

Location of Business:

Comments: