Land Submission Form

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First name

Last name

Borrowering Entity Name

Phone

Are you the:

Subject Property Address

Country/Region

Address

City

Zip / Postal code

Project Summary / Including Land Size

Type Of Property

Original Purchase Date and Purchase Price

Estimated AS IS VALUE

Amount of Funds put into project Since Purchase. Please describe

Currently Zoned for:

Currently Entitled Yes/No. If yes please describe

Any Utilities on Site (Electric / Phone/ Internet) Please describe

Water / Sewer/ Septic on Site? Please describe

Any Structures on Site

Current Debt / Liens

Amount of Past Due Taxes

Loan Amount Request / Terms

Loan Amount / Use Of Funds

Can you service Debt or request Interest Reserves?

How will you payoff Loan

Appraisals

Surveys

Phase I Environmental

Other

Signature / The above info is true and accurate. Please contact me via email or telephone

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