Broker Details (If Applicable)

Broker Name:

Broker Company:

Broker Phone:

Broker Email:

Brokerage Amount:

Borrower 1

Full Name:*

Phone:*

Email:*

Borrower 2

Full Name:

Phone:

Email:

Company (If a Borrower)

Company Name:

ABN or ACN:

Contact Name:

Contact Email:

Company Phone:

Loan Particulars

Loan Amount:*

Purpose of Loan:*

Term of Loan:*

Exit Strategy:*

Security Offered Property 1

Address:*

Title Particulars (Name on rates notice):*

Property Value ($):*

1st Mortgage Loan Amount ($):*

Lender Name:*

2nd Mortgage Loan Amount ($):

Lender Name:

Occupancy:*

Property Type:*

Security Offered Property 2

Address:

Title Particulars (Name on rates notice):

Property Value ($):

1st Mortgage Loan Amount ($):

Lender Name:

2nd Mortgage Loan Amount ($):

Lender Name:

Occupancy:

Property Type:

Other Comments or Questions: