*Borrower Name:

Company Name:

City/Town:

State:

*Phone Number: (NO DASHES)

Fax Number: (NO DASHES)

*E-mail address:

*Amount of Financing Requested: (NUMERICAL DATA ONLY)

Credit Score:

*Type of Financing Requested: Purchase/Refinance Bridge Loan Construction Development Mezzanine Equity

What is the property type? Apartments Office Retail Industrial Hotel Manufactured Home Community Condominium Residential Development Other

Are you a/an? Investor Owner Developer Mortgage Banker/Broker Contractor Other

How did you hear about us? Magazine Ad Personal Referral Conference Search Engine Our Website Directory Listing Email Broadcast Industry Newsletter Link from Industry Website WCG representative Other

Property location:

*Appraised Value of Property: (NUMERICAL DATA ONLY)

Describe the purchase or project:

Contact me via: Telephone E-mail