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Loan Request Form

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Name of Borrower (Individual/Entity): *

Contact Person (If borrower is an entity): *

Phone: *

Cell:

Email Address: *

Address *

City *

State: *

ZIP Code: *

Title Company: *

Closer: *

Address: *

Phone: *

Cell:

Email Address: *

Requested Close Date: *

Purchase Price: *

Estimated Cost of Repairs: *

After Repair Value: *

Address:

Sold Price:

Sold Date:

Address:

Sold Price:

Sold Date:

Address:

Sold Price:

Sold Date:

1) Scope of Work 2) Copy of Executed Contract or Assignment 3) Title Commitment 4) Evidence of Insurance

Date: *