LICENSE VERIFICATION
Are you a Licensed Real Estate Agent? Yes No If yes, what State(s) / Country are you licensed in?

VERIFICATION OF YOUR ROLE - CHOOSE ONE

1. Principal Buyer - Non Participating   You are the true principal buyer. You are not restricted to working with only one agent who exclusively represents you on the purchase of your properties. If you are a licensed real estate agent, you agree to act strictly as a Principal Buyer purchasing for your own (or entity's) account with no requirement of participating in the sharing of real estate commissions in the purchase of your properties." 2. Principal Buyer - Participating You are the true buyer. As a licensee, you feel compelled to make it a requirement that you must participate in commissions on the purchase of your properties. 3.   Buyer's Agent You are a licensed real estate agent who has full control & direct contact with the principal buyer.      Please click here and use this form. 4. Employee of the Principal Buyer (Paid by Buyer) 5. Consultant or Finder for the Principal Buyer 6. Other (Please explain)

CONTACT INFORMATION

Your Valid Email Address (Required) Name & Title Company Mailing Address City City  State, Zip Code State   Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Puerto Rico Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington (state) Washington D.C. West Virginia Wisconsin Wyoming      Zip  Office Phone  Ext. Cellular / Mobile Phone Pager Number Home Phone Fax Number Your Home Page (if any)

1031 EXCHANGE QUESTIONS
Are you in an Active 1031 Exchange? Yes No Status of your Current Property On Market (or soon to be) Accepted Contract / In Escrow / Sale Pending Closed Escrow (Sold) Closing Date / Date of Sale Sales Price Total all of Loans at Closing Your Title & Escrow Companies Your 1031 Accommodator

DESIRED LOCATION

What are your top 3 choices for Location? 1. State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Puerto Rico Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington (state) Washington D.C. West Virginia Wisconsin Wyoming    State Region -Any part of the State- Central Northern Northwestern Northeastern Northcentral Southern Southwestern Southeastern Southcentral Eastern Eastcentral Western Westcentral    City      County   2. State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Puerto Rico Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington (state) Washington D.C. West Virginia Wisconsin Wyoming    State Region -Any part of the State- Central Northern Northwestern Northeastern Northcentral Southern Southwestern Southeastern Southcentral Eastern Eastcentral Western Westcentral    City      County   3. State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Puerto Rico Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington (state) Washington D.C. West Virginia Wisconsin Wyoming    State Region -Any part of the State- Central Northern Northwestern Northeastern Northcentral Southern Southwestern Southeastern Southcentral Eastern Eastcentral Western Westcentral    City      County   Will you consider properties in all states ( Nationwide )?    Yes No

YOUR ACQUISITION CRITERIA

Price Range Between   and   # of Properties Wanted  One Property  or...            &nb sp;    Between   and   Properties Total Equity (Cash) What is the amount of equity you have (or being sheltered)?   Desired LTV Your new loan should be a minimum of   but not exceed  of the purchase price Desired CAP Between   and   Desired Cash on Cash Between   and   Readiness When will you be ready to write offers?

YOUR SENIOR CARE PROPERTY ACQUISITION CRITERIA

Type of Property You prefer...  All Senior Care Properties Assisted Living Facility Personal Senior Care Home Residential Senior Care Home Special Care Residence Retirement Community Senior Apartments Alzheimers / Dementia Care Personal Care Center Senior Care Residence Senior Center Skilled Nursing Facility Property Condition You prefer...         Value added through redevelopment, rehab, management       turnaround, releasing, expansion or retrofitting         Leased Up and Turnkey

IN YOUR OWN WORDS
Describe what you think would be your ideal property.