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
REFERRER ONLY (IF NO
REFERRER, LEAVE BLANK)!!!
Referrer Name:
Referrer Ph#:
Referrer Email:
Relationship To Borrower (ie
Realtor, Mortgage Broker,
CPA, Friend):
Other Notes/Comments:
(To give proper credit for the
referral, we must have this
information to make sure you get a
“thank you” fee for bringing us this
borrower and on all future business
to link you always to this borrower
on ALL future business)
Borrower 1 Name:
Contact Phone:
Email:
Resides in (City, State):
Mid-FICO:
# Late Mortgage Pmts Last 24 months:
Liquid Funds (cash, lines of credit, securities): $
# Other Properties Owned:
Borrower 2 Name:
Contact Phone:
Email:
Resides in (City, State):
MID-FICO:
# 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:
Subject Property (City, State):
Property Type (circle): SFR/2-unit/3-unit/4-unit
Acquisition Price: $
Rehab Cost: $
After-Repair Value: $