SUBMISSION FORM FLORIDA LOANSUBMISSION FORM Please send submission form and documents to: Pedro Nivela | info@pncprivatecapiotal.net| 305-968-9407 Submission Date: BORROWER INFORMATION Borrower Name Guarantor Name Guarantor Email Guarantor Phone Guarantor Name Guarantor Email Guarantor Phone Property Type (Requested) (select)ResidentialCommercialLandRehabConstructionOther (specify here) Is the property managed by a Homeowners Association? (select)YesNo Property Street Address (Requested) City (Requested) State (Requested) Zip Code (Requested) Purchase Price Refinance Value Mortgage Payoff Amount Loan Request LTV/CLTV Blanket Loan (select)YesNo Occupancy (select)PrimaryInvestor Close Date BROKER INFORMATION Broker Company (Requested) Broker Points MLO Name (Requested) MLO Phone (Requested) MLO Email (Requested) Processor Name Processor Phone Processor Email TITLE AGENT FOR PURCHASES (Benworth appoints the title agent for refinance transactions) Title Agent Name Title Agent Phone Title Agent Email Clear FormSend Close Por Favor complete todos los Campos A ocurrido error y no se a enviado el Formulario Formulario enviado correctamente
