Please Fill Out And Turn In
This Form Before Leaving
Name _______________________________________________ Date ____________
Address ______________________________________________________________
City____________________________________State _________Zip _________
Phone Day ________________ Eve _________________ Fax _______________
YES! I would like to get started as soon as
possible. Please call me when you get
a loan to place.
YES! I’m very interested but I have some
questions I’d like to discuss one-on-one.
Please contact me to schedule a
meeting.
NO! I’m just not ready to be a private lender at this time.
I have some friends I believe would like to learn about private lending.
You May May not use my name when contacting them.
Name ______________________________________ Phone __________________
Name ______________________________________ Phone __________________
I have available for lending at this time.
| $5,000 - $25,000 | $25,000 - $50,000 | $50,000 - $75,000 |
| $75,000 - $100,000 | $100,000 – Plus |
Part or all of my funds are in an IRA Yes No