Names: __________________________________________________________________

Address _________________________________________________________________
Street City State Country

Loan Purpose: ( check one )
__ Purchase ____________
__ Refinance ____________ if Refinance, current balance $_____________.

Contract Price/Estimated Value: $_______________.

Loan Amount Requested: $_______________.

Property Type (i.e. hotel, multi-family, retail, office, etc.): _____________________________.

# of Rooms/Rental Units: ______________.

# of units Leased or average yearly occupancy: ______________.

Gross Rental Income or Gross Sales: $_______________.

Annual Operating Expenses: $_______________ (Before Mortgage Principal & Interest).

Building Square Footage: _______________.

Land Square Footage: _______________..

Current Zoning: _______________.

Net Operating Income before Taxes: $_______________.

We will need the following to prequalify your loan. ____Application
____Credit Report
____Personal Financial Statement
____Resume on Borrowers
____W-2s (Three most recent years) (if applicable)
____Paystubs covering most recent month( with YTD) (if applicable)
____List All Liquid Assets (with account #s for possible verification)
____(3) years Personal Tax Returns
____(3) years Business Tax Returns (schedule "C", 11205, corporate returns, etc.)
____(3) Business P&L and Balance Sheets (Up to date)
____Multi-family Questionnaire (We will provide)
____Copies of All Leases
____Details of Operating Expenses
____Copy of Sellers Schedule E (To develop annual cost breakdown)
____Copy of Listing Brokers Property Fact Sheet(s) and Promotional Literature, if any
____Copy of Sales Contract
____Copy of Deed, Hazard & Flood Insurance Declarations Page (Refi)
____Copy of most recent tax bill
____Photos of Subject Property
____Articles of Incorporation, Copy of Trust, etc.

In the case of B & Bs, Motels and Hotels, please be sure that the TOTAL SALES figure on your Schedule "C" for the year equal the top line of your income and expense statement for the year and the total sales reported on your sales tax (state) reports for the year.

I hereby give permission to have Russell Willis Rodgers, a Licensed Mortgage Brokerage Business check my credit.

____________________________________
(Signature of Individual)

____________________________________
(Signature of corporate officer - necessary only if applying as a corporation).

Fax this form to:

Russell Willis Rodgers
Licensed Mortgage Business
670 2nd St. N Units C
Safety Harbor, FL 34695-3563

Phone: (727) 669-1600
Fax: (810) 213-0244