NBP Insurance Brokerage, Inc.
Commercial Loan - Get a Quote 
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Full Name   *
Address   *
Town   *
State   *
Zip Code   *
Business Phone   *
Home Phone   *
Best Time to Call 
E-mail Address   *
Occupation   *
Employer   *
Social Security #   *
Loan Details
Property Name 
Street address 
City 
State 
Zip code 
Property type 
Number of Units/Tenants/Rooms 
Sq. Ft. (Net Rentable) 
Currently Occupied   %
Year Built   
Loan Request  $
Loan Term Request 
Type of Loan 
Reason for Loan Request
(if other, pls, specify) 
Has the Property ever been in Bankruptcy? 
Is there a Ground Lease? 
Any Environmental Issues at the Property?
(underground storage tanks, asbestos, etc.)
Last Year Revenue  $
Last Year Expenses (excl. capital expenses, interest, depreciation & amortization)  $
Last Year Net Operating Income   $
Borrower Information
Borrower Name 
Street address 
City 
State 
Zip code 
Phone 
Fax 
E-mail 
Applicant Information
Profession 
Please fill out the following information if different than Borrower above
Applicant Name 
Street address 
City 
State 
Zip code 
Phone 
Fax 
E-mail 
Additional Comments:
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