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Historical Property Vacancy Rate:

Historical Market Vacancy Rate:

Historical Property Rate of Return:

Historical Market Rate of Return:

* Provide information for at least the most recent, and preferably all years. Exclude mortgage from expense numbers.

INCOME HISTORY

Projected

Number of Units Occupied:

Number of Leases in Place:

Annual Rental Income:

Potential Rev From Vacancies:

Annual Operating Expense:

Annual Property Taxes:

Annual Property Insurance:

Business Name:

Business description:

Legal Structure:

Yr. Started:

Business Location:

Fed Tax ID:

Business Street:

State:

City:

Zip:

* Provide information for at least the most recent, and preferably all years.

HISTORICAL CASH FLOW

Projected

Period End Date:

Number of Months in Period:

Annual Sales/Revenue:

Officer Compensation:

Interest Expense:

Depreciation:

Amortization:

Rent:

Annual Net Income:

Add Back 1:

Tax Returns Available:

Yes

Yes

Yes

Name

SSN

Ownership %

On Title

Yes No

Yes No

Yes No

Yes No

Yes No

Creditor Name

Balance

Monthly Payment

Business Declarations

Neither my business, nor any principal of my business is a party to any lawshit.

True False

My business has never defaulted on any Federal debt icluding SBA loans.

True False

No principal of my business has had a property foreclosed within the past 7 yrs.

True False

I have not had a business or occupational license revoked within the past 7 yrs.

True False

Please explain any declaration with a "False" response: