Referral Mortgage, Inc.

Unit Type:

Unit Count:

Avg Sq.Ft./Unit:

Avg $Rent/Unit:

Commercial Loan Request

Fill out the following information to submit a Loan Request at no cost. RMortgage.com provides fast mortgage approvals with our online commercial application. There is absolutely no obligation for this free service. Your application will receive top priority and immediate attention.

Provide Your Contact Information *All fields in Red are required*

First Name:

Last Name:

Company:

Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Email Address:

Contact Role:
Buyer/Investor Mortgage BrokerDeveloper
Owner Sales Broker Other (specify)

Preferred Method of Contact:
PhoneEmail

Borrower Information (Only if different from contact information)

Borrower's First Name:

Borrower's Last Name:

Borrower's Company:

Borrowing Entity Type:

Borrower's Phone Number:

Borrower's Email Address:

Borrower's Role:

Buyer	Owner
Developer	Other (specify)

Describe Your Financing Needs

Loan Amount ($): $200,000 Minimum

Purpose of financing:

Purchase	Refinance
Construction	Refinance w/ Cash Out
Second Mortgage	Other (specify)

Loan Type:

Interest Rate Type:

Amortization (for Permanent Loan):

Loan Term (for Permanent Loan):
(For multiple selections -- hold down the Ctrl
or Command key as you click on each selection)

Rank your loan preferences:

1st Preference:

2nd Preference:

When do you need the financing?

If Purchase, is sale contract executed?

YesNo Price $

If Refinancing, balance of Existing Debt ($)

If Refinancing, remaining term of Debt

years

If Refinancing, rate of Existing Debt (%)

If Refinancing, prepayment penalty?

YesNo

Property Information

Property Value: ($)

Property Name:

Property Address:

Property City:

Property State:

Property Zip:

Property Location:

Property Type:

Property Grade:

Construction Type:

# of Units:

# of Stories:

# of Buildings:

Total Building Sq Ft:

Office Sq Ft:

Retail Sq Ft:

Multi-Residential Sq Ft:

Industrial Sq Ft:

Restaurant Sq Ft:

Meeting Room Sq Ft:

Total Rentable Sq Ft:

# of Elevators & Lifts:

Is property sprinklered?

YesNo

Lot Size Sq Ft:

# of Parking Spaces:

per 1,000 sq ft.

Year Built:

Only complete this additional property information for Multi-Residential and Self Storage properties

Property Sub-Description: (Multi-Res Only)

Is building climate controlled? (self storage only)

YesNo

Estimated traffic count / day: (self storage only)

Estimated Income / Commercial Tenants $:
(self storage only)

Only complete this additional property information for Office, Industrial, Retail, and Mixed Use properties

Property Sub-Type:

Property Sub-Description: (retail only)

# of PAD sites: (retail & mixed use only)

Rail Served?

YesNo

Clearance:

feet

# of Dock High Doors:

# of Grade Level Doors:

Credit Tenant(s)?

YesNo

How Many Tenants:

Largest Tenant Names:

Lease Sq. Ft.

Start Date: (mm/dd/yy)

End Date: (mm/dd/yy)

Only complete this additional property information for Small Business property

Type of Business:

Business Description:

Is your business a franchise?:

YesNo

If Yes, name of franchise?:

# of Stores Owned:

Total # of Employees:

Only complete this additional property information for Senior Housing property

Property Sub-Type:

# of Beds:

What are the amenities?:

What public or private transportation services are available?:

Do your residents pay admission fees?:

YesNo

Do residents receive Medicaid help?

YesNo

Is property 100% private pay?

YesNo

Only complete this additional property information for Hotel property

Property Sub-Description:

Affiliation:

FlagNo-Flag

# of Available Days:

# of Rooms:

# of Beds

Average Annual Occupancy (%):

Average Daily Rate ($):

Only complete this additional property information for Mobile Home Park property

# of Homesites

Unit Type:	# of Units	Avg Rent ($)	Avg Age (yr)	# For Sale	# of Signed Leases
Single Wide:
Double Wide:
Triple Wide:
RV
Other

Homesite Construction Type:

Tenant Profile (%):

% Families

% Adult In Retirement

What are the amenities?:

Is sewer & water connected to a municipal system?:

YesNo

Are the streets paved?:

YesNo

Do the streets have curbs?:

YesNo

Acreage:

Density:

Third Party Reports

Do you have an Appraisal?: YesNo

Date of Appraisal (mm/dd/yy):

Value of Appraisal: ($)

Do you have an Environmental Report?: YesNo

Date of Report (mm/dd/yy):

Do you have a Structural/Engineering Report?: YesNo

Date of Report (mm/dd/yy):

Do you have a Termite Report? YesNo

Date of Report (mm/dd/yy):

Rental rates compared to area's market rates: AboveEqualBelow

Is this a stabilized operating property? YesNo

Property Cash Flow

Choose One: Last Full YearTrailing 12 MonthsPro Forma

Income	Cash Flow
Annual Potential Gross Rent/Income ($):	$
Food & Beverage Income ($):	$
Other Income ($):	+

Annual Potential Gross Income ($):	$
Less Actual Vacancy Percent (i.e. 5 = 5%):	–%

(A) Annual Effective Gross Income ($):	$
Expenses (excluding depreciation, amort., & interest)
Management Fee ($):	$
Marketing Expenses ($):	+
Franchise Fees ($): if applicable	+
Real Estate Taxes ($):	+
Insurance ($):	+
Utilities ($):	+
Maintenance & Repair ($):	+
Furniture, Fixtures, & Equipment ($): if applicable	+
Other Operating Expenses ($):	+
Annual Replacement Reserves ($):	+

(B) Total Annual Expenses ($):	$
Net Operating Income ($):(A-B)	$
Annual Tenant Improvements ($):	$
Annual Leasing Commissions ($):	$

Additional Information

The submission of information to the RMortgage web site is subject to your acceptance of terms and conditions, including without limitation that you agree to (i) guarantee the accuracy of the information, and (ii) indemnify and hold harmless RMortgage. from any cost, damages or liability arising out of or related to your failure to comply with the foregoing obligations. BY CLICKING THE "Submit Loan Request" BUTTON YOU REPRESENT THAT YOU HAVE READ, UNDERSTOOD, AND AGREED TO THE FULL TERMS AND CONDITIONS LINKED HERETO AS WELL AS THOSE EXPRESSLY SET FORTH ABOVE.