Fund-A-Flip Request Form (DPS)

Please be sure to submit this form 7-10 days prior to closing to allow appropriate time for the underwriting process.

Name:

Property Address:

Purchase Price:

Amount Requested:

Re-Sale Price:

Attorney and/or Closing Agent (Representing Applicant)

Name:

Address:

Phone/Fax/Email:

A-B Closing Date:______

B-C Closing Date: ______

Comments:______

Please upload this completed form to your DPS Online Transaction Management Area. Completing the DPS submission form creates a unique transaction for each deal. To view or upload additional files, select the “View Submitted Properties” link on the Deal Partnering tab within your Mentorship Resource Site to log in.

Mentorship–Partnership Support: (607) 301-0411 or

Funding Specific Support: (607) 936-2200 x 224 or

I understand that false or misleading information given in this application will result in cancellation.I authorize investigation of all statements contained in this application as may be necessary in the funding process.

Signature of ApplicantDate

COMPANY INFORMATION:

Company Name:

DBA’s or Affiliates:

Company Address:

Phone #:Fax #:

Email Address:Web Address:

Corporation Partnership LLC or Sole Proprietorship

Federal Tax ID #:

List full names and the % ownership of all owners with > 25% interest:

OTHER INFORMATION:

Are any of the owners / officers a licensed realtor, licensed real broker, or licensed mortgage broker? No If yes, please list names, license type, license #:

Have any of the owners / officers participated in educational programs for legally and ethically buying and selling short-sale properties, distressed sales or REO purchases from lenders?

No If yes, please list programs / dates attended /explain in as much detail as possible:

Have any of the owners or officers and /or directors been convicted, plead guilty or no-contest to a crime? No If yes, please explain in detail:

Are you, the company or any of the owners or officers and /or directors of the company party to a lawsuit? No If yes, please explain in detail:

Are there any outstanding judgments against you, the company, or any of the other owners and/or directors of the company? No If yes, please explain in detail:

How many short sale / REO purchases have you done in the past 2 years?

For eachowner 25% and/or officer active in the business:

Name:

Home Address:

Social Security #:DOB:

In addition, please scan to Fund - A - Flip a legible copy of your driver’s license.

I certify that the information above is true and correct and authorize Fund - A - Flipor their affiliates to perform any background checks as they deem necessary at their own expense..

Signature: ______Title: ______Date: ______

Name:

Home Address:

Social Security #:DOB:

In addition, please scan to Fund - A - Flip a legible copy of your driver’s license.

I certify that the information above is true and correct and authorize Fund - A - Flip or their affiliates to perform any backgroundchecks as they deem necessary.

Signature: ______Title: ______Date: ______

Name:

Home Address:

Social Security #:DOB:

In addition, please scan to Fund - A - Flip a legible copy of your driver’s license.

I certify that the information above is true and correct and authorize Fund - A - Flip or their affiliates to perform any background checks as they deem necessary.

Signature: ______Title: ______Date: ______