All * fields are required

Name of Organization* Primary Phone Number & Ext*
501 (c) 3 Designation / Employer Identification Number (Tax ID)* Fax Number
Street Address* City*
State* Zip Code*
Senior Pastor’s Name* Contact Person for Loan*
Title of Contact Person* Cell Phone Number*
Contact Email* Loan Type *
Requested Loan Amount* Approximate Property Value
The above named organization hereby applies for a loan with High Tower Capital, Inc. We understand that this application is to be submitted only with all financial and statistical information requested by High Tower Capital, Inc. The authorized corporate officers signed below hereby certify that all information provided in connection with this application is accurate and complete.