Before completing this application we ask four questions:

1) Is the loan requested to be secured by Real Estate?
2) Is the Real Estate located in California?
3) Is your loan request for a minimum of $30,000?
4) Do you have reasonable ability to make payments?

ONLY if you can answer “YES” to all four questions, please continue!

BORROWER

First Name (Required):	Last Name (Required):
Phone # (Day):	Phone # (Evening):
Email Address (Required):	Preferred Method Of Contact:
SUBJECT PROPERTY - CALIFORNIA ONLY
All Loans Must Be Secured By Real Estate
Address: (Required)	City: (Required)
State: (Required)	Zip Code:
Property Type:	Property Description:
NEW PURCHASE
Purchase Price $:	Down Payment $:
REFINANCE
Date Purchased:	Purchase Price$:
Estimated Value $:	Per Recent Appraisal ?
EXISTING LOANS
1ST Loan Balance = $	2ND Loan Balance = $
3rd Loan Balance = $	Additional Liens = $
LOAN REQUEST
Minimum Loan = $30,000
Loan Amount Requested: (Required)	New Loan Position:
Purpose of Loan (How Funds Will Be Used) :	Comments:
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