Your First name Your Last Name Entity name * Social security number * Date of birth Are you married? Yes No Mailing address Own / Rent Own Rent Best contact phone number * Mobile Work Home Main Work Fax Private Fax Other Email address * Other Home Work Employment status Employed Self-employed Retired Other Employer Name Years in this Job Years in this Occupation Job Title / Position Gross monthly income USD EUR Start date (Use YYYY-MM-DD for date and HH:MM:SS for time) Date Time Date Time Business Phone Mobile Work Home Main Work Fax Private Fax Other Do you have other employment history in the last 2 years? If YES, please explain by emailing your Baker Collins representative. Yes No Credit Score Total liquid cash assets USD EUR Sources of your liquid cash assets Checking account Savings account IRA Stocks Years of experience in real estate investing # of properties bought and sold: Years of Construction/Rehab experience # of current projects Total properties currently owned: How many of them are rented? How many of them are vacant? How many of them are pending sale? What are your Private Mortgage Balances? USD EUR Are you working with a partner? If you are working with a partner, they must also complete this form. Yes No Property Address Type of loan Fix and Flip New Construction Refinance Exit Strategy Rehab & Rent Rehab & Sell Rehab & Lease-Option Loan Amount Requested USD EUR Downpayment USD EUR Purchase Price USD EUR Rehab Budget USD EUR After Repair Value (ARV) USD EUR Are you adding sq. ft. to the property? Yes No Are you adding bedrooms to the property? Yes No Are you adding bathrooms to the property? Yes No Are there any outstanding judgements against you? Yes No Have you been declared bankrupt within the last seven (7) years? Yes No Have you or any other entity of which you were/are a principal been in foreclosure or had any property that was foreclosed upon? Yes No Are you party to lawsuit? Yes No Are you presently delinquent on any federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? Yes No Have you ever been convicted of a felony? Yes No Are you in a Civil Union or a Domestic Partnership, or do you have a non-borrowing spouse, or are you a party to a Designated Beneficiary Agreement? Yes No Are you a US citizen? Yes No Are you a permanent resident alien? Yes No Do you intend to occupy the property as your primary residence? Yes No Which of these documents have you attached to this form? Readable color copy of driver’s license Last 2 months bank statements Tell us more about your deal Borrower Acknowledgement * In applying for a loan or prequalification, I/we have made various statements about my/our income, assets, experience and other pertinent information LSI Mortgage Plus and its associates/affiliates. is relying upon for final loan approval. LSI Mortgage Plus and its associates/affiliates reserves the right to change the terms & conditions of any approval subject to the validity of the information provided to us. I/we understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make false statements when applying for this mortgage, as applicable under the terms and provisions of Title 18, United States Code, Section 1014. I/we authorize LSI Mortgage Plus. & their affiliates to verify any statements made or information provided, including obtaining a background check and copy of my/our credit report. I/we understand this will be used for the purpose of purchasing investment Real Estate Property. I/we understand that completion of this form does not guarantee loan approval. Loan terms will be based off of credit score, appraisal and the renovation report. By clicking “I agree” to this statement, I/we digitally sign this statement and agree to its terms. I agree I do not agree Attachments Submit
