Brokerage Required Introducer Contact Name: Loan Amount: $ Interest to be retained: $ Expected Settlement Date: Is this date critical? Loan Purpose: (include Purchase Price) Eventual repayment strategy for loan: 1. Security Address Value of Property: $ Title Reference Date Property Purchased & Purchase Price Property Type (eg: Residential/commercial) Improvements Rates Outstanding: $ Current Mortgagee/s and/or Caveat/s Current Facilities with the mortgagee/s and/or Caveat/s (eg: Loans, Line of credit, Overdraft, Credit card, etc.) 2. Security Address Value of Property: $ Title Reference Date Property Purchased & Purchase Price Property Type (eg: Residential/commercial) Improvements Rates Outstanding: $ Current Mortgagee/s and/or Caveat/s Current Facilities with the mortgagee/s and/or Caveat/s (eg: Loans, Line of credit, Overdraft, Credit card, etc.) 3. Security Address Value of Property: $ Title Reference Date Property Purchased & Purchase Price Property Type (eg: Residential/commercial) Improvements Rates Outstanding: $ Current Mortgagee/s and/or Caveat/s Current Facilities with the mortgagee/s and/or Caveat/s (eg: Loans, Line of credit, Overdraft, Credit card, etc.) Borrower/Applicant Company: ATF ACN: Trusts ABN: Directors Full Name/s: Trading Address : Registered Office Address Send
