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Georgia Capital, LLC
3525 Piedmont Road
6 Piedmont Center, Suite 305
Atlanta, GA 30305
Phone: 404-256-3006
Fax: 404-256-3011
Toll Free: 866-777-4808
info@georgiacapital.com

 

Borrower Information  
   
Name
Company
Street Name
City
State
Zip Code
Phone
Fax
Email Address
 
Broker's Information  
 
Broker Name
Company
Street Name
City
State
Zip Code
Phone
Fax
Email Address
 
Loan Information  
 
Loan Amount
Loan Purpose
Description of Collateral
AS-IS Market Value
Disposition Value (180 Day Sale Value)
Existing Debt on Collateral
Exit Strategy / Repayment Plan
Additional Collateral & Debt
 
Acknowledgement  
 
Applicant Signature
Date
   
 
©2006 Georgia Capital