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First Name: Last Name: Email Address: Phone Number: BMC Represntative: Loan Type: Acquisition Cash Out Refinance Refinance Property State: Loan Amount: Current Loan Balance (if refinance): Security Code

Role In Transaction: Principal Sales Broker Mortgage Broker Other How did you hear about BMC Captial: Internet Sales Broker Friend/Colleague Other Comments: Property Type: Multi Family Single Tenant Retail Office Hotel MHP (Mobile Home Park) SBA - Owner User Real Estate Property City: Property Value: Net Income: Amortization: