Borrower Name Borrower Address Borrower City Borrower State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucy Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington DC Washington West Virginia Wisconsin Wyoming Borrower Zip Borrower Telephone Borrower Fax Borrower E-mail Exact Name of Property Property Address Property City Property State Property Zip Type of Property (motel, shopping center, garage, etc.) Square Footage of Property or Number of Units Amount of Loan Requested ($500,000.00 minimum.) Addtional Comments