INVESTMENT REQUEST FORM * All information will be kept confidential *   * First Name:     * Last Name:       Address:      * City:      * State:      * Zip Code:      * Phone:        Fax:      * Email:      * Do you want to make 12% return on your investment?  Yes    No     * Have you loaned on real estate before?  Yes    No       * How much are you looking to invest?   $5,000 - $25,000   $25,000 - $50,000   $50,000 - $75,000   $75,000 - $100,000   $100,000 - Plus    * Are part or all of your funds in an IRA?  Yes    No         * What is the best time to reach you?    *Required Fields       Please Click Only Once.