Draw Request

Date Submitted*
MM slash DD slash YYYY
Subject Property*
Street Address Address Line 2 City State ZIP Code
Name*
First Last
Phone*
Email*
Contractor Name*
First Last
Contractors Phone*
Lock Box Code*
Amount of request*
Percentage of rehab completed*
Amount already received*
Balance remaining*
This is draw number?*
Expected date of completion*
MM slash DD slash YYYY
Are there any outstanding code violations*
- Yes
- No
If yes have they been inspected and approved?*
- Yes
- No
This draw is for the following completed items*
Please list each line item from your submitted rehab worksheet that you are ready to have inspected for this draw release.
Draw funds are paid to borrower directly via WIRE. You must supply your bank wiring instructions with your submission.*
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Name
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