REAL ESTATE PRIVATE MONEY LENDERS TO DEVELOPERS, CONTRACTORS AND FLIPPERS

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AUTHORIZATION RELEASE

For Personal Data Record Information

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To Whom It May Concern:                                                                Date:_____________  20___.

 

I hereby authorize and request any employer, police department, law enforcement, credit bureau, financial institution and any and all persons having personal knowledge aboutme, to furnish the bearer of this release with the answers to any information within their knowledge regarding me.

 

I agree to hold any and all parties blameless and free of any liability for releasing any truthful information that is within their knowledge or records.

 

I am willing to have a photocopy of this authorization be accepted with the same authority as the original.

 

Based upon this authorization request I waive any written notice from a present or former employer.

 

Last Name: __________________________ First Name: ___________________ MI: _________

Social Security Number:_______________________ Date of Birth: _________________________

Driver’s License or ID Number:_____________________________________________________  Current Address:  __________________________________________   Apt# ______________

City: __________________________________ State: _______________________________

Zip Code: ________________________ Sq. Ft. of the Property: ___________________________

Zillow, Redfin, and other estimates of the property’s value___________________________________

Loan Amount Requested: ________________________________________________________

Bedrooms in the Property:___________________Bathrooms in the Property:___________________

Cost of the existing building or land you seek to develop or flip________________________________
Home Phone Number: ____________________ Name this phone is listed under:_________________

Cell Phone Number: ______________________Name this phone is listed under:_________________

Email ___________________________________

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Have you ever been a plaintiff or defendants in any court of law?_____ If YES, please explain.

_________________________________________________________________________

_________________________________________________________________________​

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Print Name: ____________________________________​

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Signature: ______________________________________

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PLEASE RETURN THIS APPLICATION VIA EMAIL OR TAKE A PICTURE WITH YOUR PHONE AND EMAIL IT TO ALI@DOMU.NYC, RAZA@DOMU.NYC, X.UNYPO@GMAIL.COM AND YOU CAN TEXT A PHOTO OF THIS APPLICATION TO 646-801-5150 / 646-389-0508​​​​