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LOAN SUBMISSION

BORROWER/LOAN INFORMATION
	Borrower's Name:
	Borrower's Phone:	ext:
	Address:
	City:
	State (California Only):		Zip code:
	Property Type:	Residential Mixed Use Office	Industrial Retail Multi-Family	Owner Occupied Non Owner Occupied Other
	Market Value: (Estimate)	$	Currently Owed:	$
	What Borrower Wants:

BROKER INFORMATION
	Company:
	Your Name:*
	Address:
	City:
	State:		Zip code:
	Phone:*	ext:	Mobile/Pager:
	Fax Number:
	E-mail Address:*
	How did you hear about us:

Note: * indicates required information

If you prefer to fax this loan submission, please download this form, fill it out and fax it to 949.349.1330

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	Copyright © 2012 Alliance Portfolio Private Equity Finance. All rights reserved. Real Estate Broker California Department of Real Estate 01868859 Broker License ID - NMLS # 324460	800.363.1456 • 949.349.1329 Fax 949.349.1330