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Today's Date:
mm/dd/yy
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Name of Borrowing entity:
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List State Corporation duly incorporated in:
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Principal Office address:
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Please provide the following contact information:
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Authorized name signature for financing:
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Name of Project:
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Location/Complete property address:
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Property/Project Description:
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Purchase: Yes No
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Borrower (s) Name:
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Amount Requested:
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Use of Funds:
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Collateral:
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Management:
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Projected commencement date:
mm/dd/yy
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C.O. Value upon completion:
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12 month operating history:
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Gross Income upon completion with 12 month operating
history:
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NOI for the same period:
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Escrow for deposit or capital infusion Yes No
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If yes, state location and amount:
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Type of loan:
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Submitted by:
Please review your entries carefully before submitting your application.