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Rehab Funding’s

Quick App
Return by fax to (319) 937-1147
Or scan & email to rehabfundingrep@gmail.com
Questions? Call (516) 425-3366

THIS BOX TO BE FILLED OUT BY Borrower 1 Name:


REFERRER ONLY (IF NO
REFERRER, LEAVE BLANK)!!! Contact Phone:

Referrer Name: Email:


Resides in (City, State):
Mid-FICO:
Referrer Ph#:
# Late Mortgage Pmts Last 24 months:
Liquid Funds (cash, lines of credit, securities): $
Referrer Email:
# Other Properties Owned:
Borrower 2 Name:
Relationship To Borrower (ie
Contact Phone:
Realtor, Mortgage Broker,
CPA, Friend): Email:
Resides in (City, State):
MID-FICO:
Other Notes/Comments:
# Late Mortgage Pmts Last 24 months:
Liquid Funds (cash, lines of credit, securities): $
# Other Properties Owned:
Borrowing Entity (circle):
Individual/Corp/LLC/Partnership
Entity Name:
(To give proper credit for the Subject Property (City, State):
referral, we must have this
information to make sure you get a Property Type (circle): SFR/2-unit/3-unit/4-unit
“thank you” fee for bringing us this Acquisition Price: $
borrower and on all future business
to link you always to this borrower Rehab Cost: $
on ALL future business)
After-Repair Value: $

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