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Date:

Private Lenders Service Request

Name: ___________________________________________________________________ Social: _____________________________ DOB: _______________________________

Address: _________________________________________________________________ City: _____________________ State: ________________ Zip: __________________

Phone Numbers and Contact Information Home: ___________________ Fax: _____________________ Work: ________________ Cell: _________________

Email: ________________________________________

Asset Based Loan

Service required:

Private Lender's Loan

Required Documents Check List:

Clear and legible copy of ID: ____

Processing Fee: A $500.00 Processing Fee payment is enclosed with this application. Payments are NOT REFUNDABLE once a funding request has been processed.

_________________________________________

A) Faxed or emailed copy of Personal or Business Check ___ B) CHASE Bank Invoice to my email address ___ C) Wire Transfer to the Company's account. ___ (Wiring Instructions provided upon request.) D) I will pay OCF's fees ($5,000 + 2.5 points) at Funding. Y es, email me your invoice to: ___________________________________________

All of the information you have provided in this application is true and complete. You understand that we may keep this form, whether or not you are accepted into our program. We provide a guaranteed funding service as long as your transaction meets with the requirements and guidelines as listed at our website (Clear title, no more than 60%-40% LTV, etc.) Our Private Lender service fee is $5000 + 2.5 points of the funded amount to be paid at closing with a $500 processing fee paid upfront. Our fee is independent and on top of those of the funding source. If your transaction meets the guidelines and requirements and we don't fund you the processing fee will be refunded.

Forms of Payment:

Signature

Date

Notice:

OCF Private Lending Noble Park, 5353 W Desert Inn Road, Las Vegas, NV 89146 Toll Free Phone & Fax: 888.756.0666 [email protected]

Patriots Act Disclosure Borrower Identification

To help the government fight the funding of terrorism and money laundering activities, federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. Please provide the following information. We required two forms of identification for each borrower to comply with Section 326 of the Act. Borrower's Name Address City, State Zip Loan Number Date of Birth Social Security #/Tax ID # IMPORTANT - Information listed below must be exactly as indicated on the document. Primary Forms of Identification - must display Borrower's name Document Country/State of ID Number Origin State Issued Driver License State Issued ID Card Military ID Card Passport US Alien Registration Card Canadian Driver License Secondary Forms of Identification-must display Borrower's name Document Name of Issuer on ID Number Form Social Security Card U.S. Govt. Government Issued Visa Birth Certificate Non-US/Canadian Driver License Most Recent Signed Tax Returns Fed State TIN: Property Tax Bill APN: Voter Registration Card Organizational Membership Card Bank/Investment/Loan Statements Paycheck stub with name Most Recent W-2 Home/car/renter insurance papers Recent utility bill Comments: Date of Birth Expiration Date

Issuance Date

Expiration Date

I certify that I have personally viewed and accurately recorded the information from the documents identified above, and have reasonably confirmed the identity of the applicant.

Signature Printed Name

Title Date

* For persons without a SSN/TIN, the ID number must be from one of the following: passport, alien ID card, or any other government issued document evidencing nationality or residence and bearing a photograph or similar safeguard.

Information

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