Financial Funders Unlimited

BROKER INFORMATION

NAME:

BROKER #:

COMPANY:

ADDRESS:

CITY:

STATE/PROVIDENCE:

ZIP CODE:

HOME PHONE:

BUSINESS PHONE:

CLIENT INFORMATION

NAME: *

AMOUNT DESIRED: $ *

COMPAMY: *

ADDRESS: *

CITY: *

STATE/PROVIDENCE: *

ZIP CODE: *

HOME PHONE: *

BUSINESS PHONE: *

PROGRAM REQUESTED

INSTRUCTIONS: CHECK THE PROGRAM YOUR CLIENT WISHES. IF UNDECIDED, INDICATE CHOICE, 1ST, 2ND, CHOICE, ETC.

PERSONAL: PERSONAL LOANDEBT CONSOLIDATIONDISCOUNT MORTGAGE NOTEOTHER

PURPOSE FOR THE LOAN

INSTRUCTIONS: PLEASE, DESCRIBE THE PURPOSE FOR THE LOAN. BE VERY SPECIFIC! ATTACH A SEPARATE SHEET IF NECESSARY.

CHECKLIST FOR COMPLETENESS

INSTRUCTIONS: CHECK EACH ITEM BEFORE SUBMITTING FOR FUNDING. INCOMPLETE SUBMISSIONS ALWAYS DELAY PROCESSING. PACKAGES CANNOT BE RETURNED-PLEASE KEEP A COPY FOR YOURSELF. DO NOT SUBMIT IF ALL INFORMATION IS NOT ENCLOSED.

-CREDIT APPLICATION (ALL SECTIONS COMPLETED)

-FINANCIAL STATEMENT (INCLUDING BUSINESS IF APPLICABLE)

-SCHEDULES 1-4 & 5-10

-TWO YEARS COMPLETE FEDERAL TAX RETURNS -(ALL PAGES PLEASE)

-PROOF OF CURRENT INCOME (PAY STUBS, CONTRACT, ETC.)

-SUPPORT DOCUMENTS - (APPRAISAL, PURCHASE ORDER, EQUIPMENT LIST, ETC.)