Mezzanine Financing Quote Submission Form:

1. Borrowers Name *

First

Middle

Last

2. Borrowers Phone Number *

3. Borrowers email address *

4. Is borrower a US Citizen? *

YES
NO

5. Company name the borrower is closing in (must close in a corporate entity)

6. Who makes up the entity and what are their percentages of ownership?

7. Address of Subject Property *

Address Line 1

Address Line 2

City

State

Zip Code

8. Exact Property type (Ex: Strip Mall, Office Condo(s), Warehouse, etc): *

9. How many acres of land is the property on?

10. What is the current square footage of the property?

11. Purchase Price (if purchase, PLEASE ONLY FILL THIS IN IF THIS IS A PURCHASE TRANSACTION) *

12. Is the borrower already in a purchase and sales contract

13. If in purchase and sales contract, has any earnest money been put down? If so how much?

14. Current fair market value of the property: *

15. When does the borrower need to close?

16. How much Cash on hand does the Borrower have? *

17. How much is the Primary Loan amount? *

18. How much is the Borrower seeking in subordinate “Mezzanine” financing? *

19. If refinance how much debt needs to be paid off on this Property? *

20. If Refinance, when was the Property originally purchased and for how much? *

21. What is the occupancy percentage of the property?

22. Does the Borrower, or any Business that the Borrower is a part of, occupy any part of the Property? If so, what percentage?

23. How much is the Total Monthly Rental income? (attach additional documents in needed)

24. What are the Annual Taxes on the Property?

25. What is the Annual Insurance on the Property? *

26. How many similar Properties has the Borrower BOUGHT OR SOLD in the past 3 years? *

27. How many similar Properties does the borrower currently own? *

28. Borrowers fico scores? *

29. Please list borrowers home address *

Address Line 1

Address Line 2

City

State

Zip Code

30. Does the borrower rent or own? *

RENT
OWN

31. Please list monthly payment

32. Does the borrower own any other investment properties? If so how many? *

33. Does the borrower have any IRS issues, Tax liens, judgments, past bankruptcies, past chapter filings, past foreclosures, recent or pending lawsuits against them? If so please explain and list date: *

34. Has the borrower ever had any mortgage deliquent payments? If so when were they? *

35. Is the borrower already working with another broker or lender?

YES
NO