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Commercial Loan Mod Application Form

Your Name*:
Your Email*:
Your Phone Number*:

Owner Information:

Multiple Owners:
Cell Phone:
Work Phone:
Home Phone:
Owner Email:
Company Name:
Company Address:
Property Name:
Property Address:
Is the borrower a single asset entity: Yes No
Has a Notice of Default been served: Yes No
Is there a sale date: Yes No
Sale Date:

Property Information:

Property Type:
Explain if Other:
Date Purchased:
Purchase Price:
Current Market Value:
Months Delinquent:
Number of Units:
Occupancy %:
Number of Units Vacant:
Term of Leases:
Real Estate Taxes:
Tenant Paid Expenses:
Have Taxes Been Levied: Yes No
What is the Estimated Cost of Insurance:
Any Deed or Regulatory Restriction: Yes No
When Was the Property Built:
Amount of Renovations:
Physical Condition:
Cost of Any Anticipated Repairs:
Total Rentable Sq. Ft:
If ALF, total number of beds:
How Many Vacant Beds:
Hotel/Motel is it Flagged: Yes No
If so which:
Do You Have a STAR Report: Yes No
What is Your ADR:
How Many Rooms:
Total Number of Parking Spaces:
Extra Services Available:
How Long do You Plan to Own the Property:
What is the nature of your business:
What product of service do you provide:
What is your geographic market:
Is there a management company: Yes No
Name of Company:
Estimated monthly income:
Estimated Operating Expenses:
Estimated NOI:

Loan Information:

1st Lender:
Prepayment Penalty: Yes No
Payments Delinquent:
2nd Lender:
Prepayment Penalty: Yes No
Payments Delinquent:
Cause of hardship:
Terms of 1st Loan:
Terms of 2nd Loan:
Has the hardship been resolved:
Past credit issues with borrower of principle (i.e. bankruptcy, assignment for the benefit of creditors, repossessions):
Are there any pending lawsuits:
How many properties do you own:
Are you delinquent on any: Yes No
If yes, please list here. Please provide address, Assessor's Parcel Number, the number of months you are behind and the name of the lender:
When is the best time to contact you:
Best Number to Reach You:
Please feel free to provide any additional comments or objectives here:

Attach File:

Please attach current IRA/401k balance sheet, if available.

If you have more than one document to attach please compress them into a ZIP file. By doing this you will reduce the number of attachments our system has to process and improve the response time for your request.
I have a file to attach:
Select A File To Upload: