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Whether you are investing personal or IRA funds, we simply need to know the amounts you have available and the time frame in which your funds are available. All information provided will be kept strictly confidential.
*Items marked with a red asterisk are required.
Click here to use our Secure & Confidential Questionnaire Secure Form
   C O N F I D E N T I A L   
Your Contact Information
*First Name *Last Name
Address
City State  Zip 

*Day Phone

Example: 123 456-7890

Evening Phone
*Email *Cellular/Pager
Your Investment Information
Yes, I'm interested in putting my money to work earning safe, good returns.
*I have the following funds available for investment:
Personal Funds $
IRA Funds $
Business Funds $
*Date funds will be available for use:   
*I want to make a loan to you for a:   
*I would like the payments to be: Interest Accruing
Annual
Semi-Annual
Quarterly
Monthly
I would like to know more about how to move my money from my current brokerage IRA to a
self-directed IRA so I can make loans to you.
I would like to know more about the interest accruing account.
Do you have any questions or comments you would like to share with us?
*How did you hear about us?
C O N F I D E N T I A L

Thank you for taking the time to share your information with us.
We will review your information and contact you shortly.
If you have any problem submitting this form, please contact us and let us know.



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PLEASE NOTE: This is not a Security. The information provided herein is not intended to be for the purposes of soliciting a Security under State or Federal regulations.This information is intended to give the private investor alternatives to stock market investments, but is not intended to be a solicitation of a Security under SEC rules and definitions. This is intended to be a private borrowing transaction.