CITYRIZE

Program type

What kind of program are you looking for?

Borrower Info

First Name Last Name Borrower Email Home Phone Cell Phone Alt. Phone Is there a Co-borrower? City Address Zip Code State

Rent or Own

Length of time at the present property

Has the borrower resided at the present address for less than two years?

Mailing Address

Mailing Address same as Current Address?

Mailing Address Mailing City Mailing State

Mailing Zip Code

Personal Info

Date Of Birth

Social Security Number Marital Status?

Credit Score Range

Citizenship

U.S. Citizen Perm Resident Alien Foreign National

Borrower Background

Are you a U.S. Citizen?

Have you ever been convicted of a felony or other fraud related crimes?

Has the borrower been declared bankrupt within the past 3 years?

Are there any outstanding judgments against the borrowers?

Do you have any active lawsuits against you?

Is the borrower presently delinquent or in any default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee

Has the borrower directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?

Borrower Experience

Does borrower have Fix & Flip experience or sold any properties?

Does borrower own investment properties?

Business Entity

General Business Info

Entity Name Entity Type

State Of Formation

Federal Tax ID/EIN

Subject Property Details

Property Location

Subject Address Subject City Subject State

Subject Zip Code County

Legal Description Parcel No

Property Characteristics

Subject Property Type

Property Details

How long will it take for rehab to complete? In Month

Property Access

Who to contact for property access? Name Phone:

Loan Terms

Desired Closing Date

Desired loan amount Transaction Type

Is property in an HOA?

Acquisition / Purchase Price Will the property need rehab or construction?

Property Value (AS-Is) Initial Loan Amount Down Payment % Total Loan Amount Acquisition Down Payment

Acquisition LTV Market LTV

Additional Questions

Loan/Exit Plan

Loan/Exit Plan Explanation What is the projected rental income per month?

Title Info

Title Rep First Name Title Rep Last Name Title Company E-mail Phone #

Insurance Agent Info

Insurance Rep First Name Insurance Rep Last Name Name of Company E-mail Phone Insurance Rep Notes

Authorization to Conduct Credit & Background Check

By signing this form, I/we hereby authorize lender to conduct a background and/or credit check. Additionally, the undersigned and each party to this
loan, authorizes lender to disclose to any third party, employee, agent or assignee thereof information regarding background and credit experience.
I understand that it is a federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements when applying for this
mortgage, as applicable under the provisions of title 18, United States code, 1014. I also understand that the lender intends to use the data obtained
through the investigation for due diligence purposes only, and shall not disclose such information to any other party except as otherwise authorized above.

By checking this box I agree to the terms and conditions.

Name of person signing