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| Name:* |
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| Email:* |
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Phone: * |
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| What is the loan amount being requested? |
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| Type of Property |
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| State |
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County |
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City |
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Tax/ID Parcel Number(s) |
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Any current/delinquent loans or encumbrances against the property,
if yes what are the payoff amounts? |
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Community |
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Comments or questions? |
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| Timeframe* |
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