Crown Valley Group

Residential Loan Application

I. GENERAL INFORMATION

Borrower/Guarantor Name

Date Of Birth

Social Security Number

Home Address

City

State

Zip

Mobile Tel No

Office Tel No

Home Tel No

Fax No.

Marital Status

Years of Education

Highest Degree Obtained

Number of Dependents

II. BROKER INFORMATION

Broker Name

Company Name

Address

City

State

Zip

Mobile Tel No

Office Tel No

Fax No.

III. EMPLOYMENT

Name of Employer

Home Address

City

State

Zip

Phone

Industry

Position Held/Title

Number of Years at Current Employer

Number of Years in Industry

Annual Employment Income

Other Non-Real Estate Income

Source of Income

IV. REAL ESTATE EXPERIENCE

Number of Years of Experience

Number of Investment Properties Currently Owned

Type of Real Estate Experience (Please Describe)

V. PROPERTY UNDER CONTRACT CURRENTLY

Property Address

Must Close By Date

Expected Project Completion Date

Purchase Price

Cost of Repairs/Construction

After Repair/Construction Value

Loan Amount

Name of Contractor

Contractor's Mobile Tel No.

VI. ASSETS & LIABILITIES

A. Banks and other financial institutions where cash deposits have been maintained or loans have been obtained.

Name of Financial Institution	Account Number	Cash Deposit Balance	Loan Balance	Due Date of Loan	Type of Debt (Credit Card, Auto Loan, Student Debt etc)

B. Stocks & Bonds.

Num. of Shares	Name of Company	Brokerage Company Holding Stock	Account Number	Market Value

C. Retirement Plans

Financial Institution	Account Number	Value

D. Schedule of Real Estate Owned

Property Address	Type of Property (Residential, Apartment, Retail, Office, Industrial)	Date of Purchase	Original Purchase Price	Repairs Completed	Total Cost	Market Value	Mortgage Balance	Rental Income (per month)

VII. MISCELLANEOUS

How did you hear about us?

Are you currently working a Crown Valley representative? Yes No

If yes, please state the name of the representative

This information and the information provided on all accompanying financial statements and schedules is provided for the purpose of obtaining credit for the Applicant(s) or for the purpose of Applicant(s) guaranteeing credit for others. Applicant(s) acknowledge that representations made in this statement will be relied on by Creditor in its decision to grant such credit. This Statement is true and correct in every detail and accurately represents the financial condition of the Applicant(s) on the date given below. Creditor is authorized to make all inquiries it determines necessary to verify the accuracy of the information contained herein and to determine the creditworthiness of the Applicant(s). Applicant(s) will promptly notify Creditor of any subsequent changes which would affect the accuracy of this Statement. Creditor is further authorized to answer any questions about Creditor’s credit experience with Applicant(s). Applicant(s) are aware that any knowing or willful false statement regarding the value of the above property for purposes of influencing the actions of Creditor can be a violation of federal law, and may result in a fine or imprisonment or both.

By checking the box, applicant declares that he/she has read and understands the statement above.