Draw Request Form

Date*

From*

Phone*

Loan Number*

Email:*

Please tell us how you would like to have your checks sent to you .

Each draw has a $30.00 fee - Make sure borrower is notified of this fee

Wire Funds require an additional $30.00 Wire Processing Fee

Please tell us how you would like the payment disbursed:*

Account Holder Name:*

Routing Number:*

Account Number:*

Contact*

Contact Phone Number*

Site Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Please complete all information requested below for each draw being requested.

Draw must be approved by the Lender or Lender’s Representative, before any funds will be sent.

Description of Funds Being Requested (1)

Amount Requesting (1) $

Description of Funds Being Requested (2)

Amount Requesting (2) $

Description of Funds Being Requested (3)

Amount Requesting (3) $

Description of Funds Being Requested (4)

Amount Requesting (4) $

Description of Funds Being Requested (5)

Amount Requesting (5) $

Description of Funds Being Requested (6)

Amount Requesting (6) $

Description of Funds Being Requested (7)

Amount Requesting (7) $

Total $

Lender or Lender's Representative Approval:*

Use your mouse or finger to draw your signature above

Sent By:*