Your name*: Company name*: Your email*: Company Web Address*: Borrower name*: How Many Borrowers? Primary Contact*: Contact Email Address*: Primary Contact Phone Number*: Primary Contact Relationship to Borrower: BorrowerMortgage BrokerRealtorOtherLoan Request Amount: Borrowing Purpose: PurchaseRefinanceConstructionRenovationIncludes: Real EstateBusiness OnlyIf Purchase, is Site Under Contract? YesNoPhysical Address of Property/Business Estimated value or purchase price of property to be mortgaged: Equity/Down Payment: (if applicable) Borrowing Entity: To Be FormedS-CorpC-CorpLLCParnershipSole ProprietorshipBorrower/Guarnator Credit: ExcellentGoodFairPoorType of Property: C-StoreGas StationService StationTruck StopOtherProperty Condition: ExcellentGoodFairPoorWhen was Property Built? Building Square Footage: Land Square Footage: Number of Multi-Product Dispensers MPDs: Any Other Property Amenities (Car Wash, Vacuum, Propane, EV Charger)? How Many Underground Storgage Tanks? FiberglassSteelAge of Tanks: Are There Any Open Environmental Files with State? YesNoIs Site Currently Monitored? YesNoDo You Need Bridge Money? YesNo
