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Ellis Management Company Loan Application

Date of Request
Date Funds Required	Mo Day Year
Name of Borrower
Name
Address
Telephone Number
Cell or Mobile Number
Fax Number
Email Address
Requested Loan Amount
Terms(6,12,18, or 24 mo.
Interest Rate
Lender Points(if applicable)
Collateral
Name of Broker(if applicable)
Name
Address
Telephone Number
Cell or Mobile Number
Fax Number
Email Address
Broker Points(if applicable)