Loan Request Form
Name: (Borrower)
Date:
Address
Phone:
Credit Score:
Why Are You Looking For A Loan?
Purchase Real Estate
Re-Finance
Avoid Foreclosure
Other
If "Other" Please specify:
What Type Of Property Is It?
Bare Land
Single Famly Residence
Commercial
Other
If "Other" Please specify:
Where Is The Property Located?
Loan Amount:
Gross Household Income
Yearly
Monthly
Bi-Weekly
Underlying Debt
Amount:
Interest Rate (%):
Payment Term:
Monthly
Quarterly
Yearly
Payment Amount:
Additional Comments:
Best way to contact:
619 SW Higgins Ave., Suite O, Missoula, MT 59803
Phone (800)999-4809 Fax (406)721-1459
