Hard Money
Private Money

Richmond Mortgage Inc.

Hard Money, Private Money

5-Minute Loan Application

This loan application is for:

After filling out the form below, click ‘Submit’ at end of the form or print and fax to 804 288-1899.

Required fields are in *Bold

Borrower name:

Borrower address:

Borrower company:

Borrower e-mail address:

Borrower phone number:


Property description:

Purchase price of property:

Do you have the property under contract?
 Yes No Making an offer

Property listed on MLS, CoStar, or Loop Net?
Please check all applicable boxes:
 MLS CoStar Loop Net

If on MLS give the MLS ref #:

Name of property seller (assigned contracts require approval):

How long has the seller owned the property?:

Info on any existing leases:

How much cash do you have to put toward the project?:

If the property is a single family residence, is there a master bath and 1 full bath that is not a master bath?:

If there is not currently a master bath, do you plan on adding one?:

Construction type:
 Site-built construction Manufactured/modular construction

Rehab Checklist

Roof Needed:
 Rip & Replace (single) Full Roof (Multi) 1 Layer or Shingles Added
Roof Cost:

Exterior Paint/Siding Needed:
 Paint Siding
Exterior Paint/Siding Cost:

Garage Repair Needed:
 1 garage door w/ opener reframe structure 1 car paint 2 car paint new roof
Garage Repair Cost:

Yard Landscaping or Cleaning Needed: yes 
Yard Landscaping or Cleaning Cost:

Heating, HVAC:
 HVAC & ductwork HVAC unit only Boiler Hot Water Heater
Heating/HVAC Cost:

 Full Rough-In Minor Repair
Plumbing Cost:

 Re-wire entire house minor changes New panel
Electrical Cost:

Foundation/Basement Repair:
 Reframe support beam Replace/Sister joist Seal Basement Jack-up house Concrete
Foundation/Basement Repair Cost:

Interior Paint Needed: yes 
Interior Paint Cost:

Flooring Repair:
 Carpet Vinyl Tile Concrete Re-finish hardwood New Hardwood
Total S.F.:
Flooring Repair Cost:

Kitchen Repair/Appliances:
 Cabinets Counters Appliances
Kitchen Repair/Appliances Cost:

Bath Repair:
 Full renovation Change fixtures only
Number of Baths:
Bath Repair Cost:

Framing/Insulation/Sheetrock Repair:
 Move walls Insulation Sheetrock repair
Framing/Insulation/Sheetrock Repair Cost:

Dumpsters?: yes 
Dumpster Cost:

Porch/Deck Repair:
 Tear down & re-do new? Repair existing?
Porch/Deck Repair Cost:

Window Repair:
 Replace Storm windows
Window Repair Cost:

Well/Septic Repair:
 Well Septic tank
Well/Septic Repair Cost:

Oil Tank Repair:
 Above ground In ground
Oil Tank Repair Cost:

Demo Cost:

Other Repair Costs:


Total Rehab Cost:

Additional rehab comments:

Exit strategy: (If selling, what is your sales price):

How many fixes & flips have you done in the last 12 months? List address, purchase amount, rehab cost and sale price:

Would you like to request a pre-approval letter?:  

Send all photos, videos and attachments to: Mike@RichmondMortgageinc.com

Please contact us if you do not receive a reply within 24 hours.
Phone: 804-249-2887
E-mail: mike@richmondmortgageinc.com

Richmond Mortgage Inc.

Richmond Mortgage Inc.